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Sathianathen NJ, Furrer MA, Mulholland CJ, Katsios A, Soliman C, Lawrentschuk N, Peters JS, Zargar H, Costello AJ, Hovens CM, Bishop C, Rao R, Tong R, Steiner D, Moon D, Thomas BC, Dundee P, Calero JAR, Thalmann GN, Corcoran NM. Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes. Cancers (Basel) 2023; 16:123. [PMID: 38201549 PMCID: PMC10778356 DOI: 10.3390/cancers16010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis.
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Affiliation(s)
- Niranjan J. Sathianathen
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
| | - Marc A. Furrer
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Department of Urology, University of Bern, 3010 Bern, Switzerland; (A.K.); (G.N.T.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, 4600 Olten, Switzerland
- Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
| | - Clancy J. Mulholland
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
| | - Andreas Katsios
- Department of Urology, University of Bern, 3010 Bern, Switzerland; (A.K.); (G.N.T.)
| | - Christopher Soliman
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Justin S. Peters
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Homi Zargar
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Anthony J. Costello
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Australian Prostate Centre, North Melbourne, VIC 3051, Australia
| | - Christopher M. Hovens
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Australian Prostate Centre, North Melbourne, VIC 3051, Australia
| | - Conrad Bishop
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Department of Urology, Footscray Hospital Western Health, Melbourne, VIC 3011, Australia
| | - Ranjit Rao
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Raymond Tong
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Daniel Steiner
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
| | - Daniel Moon
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3050, Australia
| | - Benjamin C. Thomas
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
| | - Philip Dundee
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Epworth Healthcare, Melbourne, VIC 3121, Australia; (C.M.H.); (C.B.)
- Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
| | | | - George N. Thalmann
- Department of Urology, University of Bern, 3010 Bern, Switzerland; (A.K.); (G.N.T.)
| | - Niall M. Corcoran
- Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia (C.J.M.); (C.S.); (N.L.); (J.S.P.); (H.Z.); (A.J.C.); (R.R.); (R.T.); (D.M.); (B.C.T.); (P.D.); (N.M.C.)
- Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
- Australian Prostate Centre, North Melbourne, VIC 3051, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, VIC 3050, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC 3050, Australia
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Liang C, Li W, Liu X, Zhao H, Yin L, Li M, Guo Y, Lang J, Bin X, Liu P, Chen C. Effect of annualized surgeon volume on major surgical complications for abdominal and laparoscopic radical hysterectomy for cervical cancer in China, 2004-2016: a retrospective cohort study. BMC Womens Health 2023; 23:69. [PMID: 36793026 PMCID: PMC9933338 DOI: 10.1186/s12905-023-02213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Previous studies have suggested that higher surgeon volume leads to improved perioperative outcomes for oncologic surgery; however, the effect of surgeon volumes on surgical outcomes might differ according to the surgical approach used. This paper attempts to evaluate the effect of surgeon volume on complications or cervical cancer in an abdominal radical hysterectomy (ARH) cohort and laparoscopic radical hysterectomy (LRH) cohort. METHODS We conducted a population-based retrospective study using the Major Surgical Complications of Cervical Cancer in China (MSCCCC) database to analyse patients who underwent radical hysterectomy (RH) from 2004 to 2016 at 42 hospitals. We estimated the annualized surgeon volumes in the ARH cohort and in the LRH cohort separately. The effect of the surgeon volume of ARH or LRH on surgical complications was examined using multivariable logistic regression models. RESULTS In total, 22,684 patients who underwent RH for cervical cancer were identified. In the abdominal surgery cohort, the mean surgeon case volume increased from 2004 to 2013 (3.5 to 8.7 cases) and then decreased from 2013 to 2016 (8.7 to 4.9 cases). The mean surgeon case volume number of surgeons performing LRH increased from 1 to 12.1 cases between 2004 and 2016 (P < 0.01). In the abdominal surgery cohort, patients treated by intermediate-volume surgeons were more likely to experience postoperative complications (OR = 1.55, 95% CI = 1.11-2.15) than those treated by high-volume surgeons. In the laparoscopic surgery cohort, surgeon volume did not appear to influence the incidence of intraoperative or postoperative complications (P = 0.46; P = 0.13). CONCLUSIONS The performance of ARH by intermediate-volume surgeons is associated with an increased risk of postoperative complications. However, surgeon volume may have no effect on intraoperative or postoperative complications after LRH.
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Affiliation(s)
- Cong Liang
- grid.416466.70000 0004 1757 959XDepartment of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, 510515 China
| | - Weili Li
- grid.416466.70000 0004 1757 959XDepartment of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, 510515 China
| | - Xiaoyun Liu
- grid.413390.c0000 0004 1757 6938Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongwei Zhao
- Department of Gynecology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Lu Yin
- grid.416466.70000 0004 1757 959XDepartment of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, 510515 China
| | - Mingwei Li
- grid.459671.80000 0004 1804 5346Department of Obstetrics and Gynecology, the Jiangmen Central Hospital of SUN YAT-SEN University, Jiangmen, China
| | - Yu Guo
- grid.440151.5Department of Gynecology, Anyang Tumor Hospital, Anyang, China
| | - Jinghe Lang
- grid.506261.60000 0001 0706 7839Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Xiaonong Bin
- grid.410737.60000 0000 8653 1072Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, 510515, China.
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, 510515, China.
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Porcaro AB, Rizzetto R, Amigoni N, Tafuri A, Bianchi A, Gallina S, Orlando R, Serafin E, Gozzo A, Cerrato C, Di Filippo G, Migliorini F, Antoniolli SZ, Novella G, De Marco V, Brunelli M, Cerruto MA, Polati E, Antonelli A. American Society of Anesthesiologists' (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients. Indian J Surg Oncol 2022; 13:848-857. [PMID: 36687253 PMCID: PMC9845474 DOI: 10.1007/s13193-022-01577-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/28/2022] [Indexed: 01/25/2023] Open
Abstract
Objective To test the hypothesis of associations of preoperative physical status system with major postoperative complications at hospital discharge in prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Materials and Methods In a period ranging from January 2013 to October 2020, 1143 patients were evaluated. The physical status was assessed by the American Society of Anesthesiologists' (ASA) system, which was computed trained anesthesiologists. The Clavien-Dindo system was used to classify postoperative complications, which were coded as major if greater than 1. Results ASA physical status system included class I in 102 patients (8.9%), class II in 934 subjects (81.7%), and class III in 107 cases (9.4%). Clavien-Dindo complications were distributed as follows: grade 1: 141 cases (12.3%), grade 2: 108 patients (9.4%), grade 3a: 5 subjects (0.4%), grade 3b: 9 patients (0.8%), and grade 4a: 3 cases (0.3%). Overall, major complications were detected in 125 cases (10.9%). On multivariate analysis, major Clavien-Dindo complications were predicted by ASA score grade II (adjusted odds ratio, OR = 2.538; 95%CI 1.007-6.397; p = 0.048) and grade III (adjusted OR 3.468; 95%CI 1.215-9.896; p = 0.020) independently by pelvic lymph node dissection (PLND) and/or blood lost. Conclusion In RARP surgery, the risk of major postoperative Clavien-Dindo complications increased as the physical status system deteriorated independently by performing or not a PLND and/or large intraoperative blood lost. The ASA score system was an effective predictor of major Clavien-Dindo complications, which delayed LOHS in RARP surgery. Confirmatory studies are required. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01577-9.
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Affiliation(s)
- Antonio Benito Porcaro
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Rizzetto
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nelia Amigoni
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Tafuri
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Bianchi
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sebastian Gallina
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rossella Orlando
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emanuele Serafin
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandra Gozzo
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Clara Cerrato
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giacomo Di Filippo
- Department of General and Hepatobiliary Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Filippo Migliorini
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Zecchini Antoniolli
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Novella
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Vincenzo De Marco
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Angela Cerruto
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Enrico Polati
- Department of Anesthesiology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Antonelli
- Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Pelvic Lymph Node Dissection at the Time of Radical Prostatectomy: Extended? Of Course Not! EUR UROL SUPPL 2022; 44:18-19. [PMID: 36043195 PMCID: PMC9420500 DOI: 10.1016/j.euros.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/29/2022] Open
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John JB, Pascoe J, Fowler S, Walton T, Johnson M, Aning J, Challacombe B, Bufacchi R, Dickinson AJ, McGrath JS. A ‘real-world’ standard for radical prostatectomy: Analysis of the British Association of Urological Surgeons Complex Operations Reports, 2016–2018. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158211063964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To produce comprehensive and detailed benchmarking data allowing surgeons and patients to compare practice against, by using all recorded radical prostatectomies across a 3-year period in England. Patients and methods: The British Association of Urological Surgeons (BAUS) manages the radical prostatectomy (RP) Complex Operations Database. Surgical departments upload data which they can review and amend before lockdown and data cleansing. Analysis of 2016–2018 data held on the BAUS Complex Operations Database was performed for 21,973 patients undergoing RP in England, producing procedure-specific benchmarking data. General linear models were used to assess differences in patient selection between different operative modalities. Analysis involved assessment of case selection, operative decisions and outcomes, case volume and pathological outcomes. Results: Using national Hospital Episode Statistics, the BAUS RP dataset was estimated 91% complete. Median age was 65 and 96% were American Society of Anesthesiologists (ASA) Grades 1–2. Over 80% had RP performed in a high-volume centre (>100 annual RPs) and 88% had Gleason grade group (GGG) ⩾2 disease on biopsy. Robotic-assisted RP (RARP), laparoscopic RP (LRP) and open RP (ORP) were performed in 85%, 7.2% and 7.7% of cases, respectively. Patient and disease characteristics differed across surgical modalities. Transfusion rates were 0.14% in RARP, 0.38% in LRP and 1.8% in ORP. Increased positive surgical margin (PSM) rates were observed with increasing prostate-specific antigen (PSA), GGG and T-stage, with comparable PSM rates across surgical modalities. Lymph node dissection was performed more commonly in high-risk cases (cT3, PSA > 20, GGG ⩾ 4). Pathological upstaging was common. Median length of stay was 1, 2 and 3 days for RARP, LRP and ORP, respectively. ORP had Clavien–Dindo complications ⩾3 and unplanned hospital readmissions. Conclusion: This analysis has enabled the first set of UK national RP standards to be produced allowing procedure, patient and disease-specific national, centre and individual comparisons. The present degree of service centralisation, operative modalities, and specific aspects of surgical practice can be observed. Level of evidence: 2b
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Affiliation(s)
| | - John Pascoe
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - Sarah Fowler
- The British Association of Urological Surgeons, UK
| | | | - Mark Johnson
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | | | | | - Rory Bufacchi
- Italian Institute of Technology, Italy
- Department of Neuroscience, Physiology and Pharmacology, University College London (UCL), UK
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Nathan A, Gershman B, Van der Poel H, Sooriakumaran P. Centralisation of Care for Prevalent Urological Malignancies: The Case for Prostate Cancer. Eur Urol Focus 2021; 7:920-923. [PMID: 34531115 DOI: 10.1016/j.euf.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
Prostate cancer presents a significant challenge and burden for health care centres across the world. In the UK and other parts of Europe, as well as areas of the USA, centralisation of services has been implemented. In the UK and Europe, hospital centres are split into a hub-and-spoke system. High-volume centres carry out treatment as hubs and local hospitals carry out diagnostics and referrals as spokes. In this narrative mini-review we evaluate whether centralisation of services has improved patient outcomes, streamlined the use of resources, and reduced costs. We also discuss the positive and negative impacts of centralisation of prostate cancer services. PATIENT SUMMARY: This mini-review discusses the current use of centralisation of prostate cancer services. We assess the evidence in favour of centralisation as well as the issues it can present to both health care systems and patients.
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Affiliation(s)
- Arjun Nathan
- University College London, London, UK; Royal College of Surgeons of England, London, UK.
| | - Boris Gershman
- Division of Urological Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Henk Van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Prasanna Sooriakumaran
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Urology Service, Digestive Diseases and Surgery Institute, Cleveland Clinic London, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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John JB, Pascoe J, Fowler S, Rowe E, Colquhoun A, Challacombe B, Bufacchi R, Dickinson AJ, McGrath JS. Setting standards for cystectomy using the British Association of Urological Surgeons Complex Operations Reports, 2016–2018. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211033481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To produce comprehensive standards for cystectomy using contemporary data collected across a nation. Patients and methods: Surgical departments upload cystectomy data to the British Association of Urological Surgeons (BAUS) Complex Operations Database. Analysis of 2016–2018 data was performed for all recorded 5288 patients undergoing cystectomy in England. Logistic regression with general linear models was used to assess differences in patient selection between operative modalities. Analysis involved assessment of case selection, operative decisions and outcomes, case volume and pathological outcomes. Results: Using national Hospital Episode Statistics, the BAUS cystectomy dataset was estimated 93% complete. Median age was 70 years (interquartile range 63–75) and 75% were male. Charlson comorbidity index ⩽2 was reported in 87%. Primary treatment of muscle-invasive bladder cancer accounted for 46% of cases. Commonest preoperative disease stages were T2N0 and T1N0 (35% and 25% respectively). Robotic-assisted (RAC), laparoscopic (LC) and open cystectomy (OC) were performed in 41%, 5.5% and 54% of cases respectively. T-stage distribution differed by operative modality. Transfusion rates were 3.7% for RAC, 6.0% for LC and 18% for OC. Increasing positive surgical margin rates were observed with increasing T-stage, up to T3. The conversion-to-open rate for minimally-invasive surgery was 1.7%. Median annual centre and surgeon case volumes were highest for RAC. Median length of stay was 7, 10 and 10 days for RAC, LC and OC respectively. Postoperative histological upstaging was common (33% of cT1, 50% of cT2 cases). Lymph node positive rates were 28% for muscle-invasive bladder cancer. Conclusion: Analysis of this data provides understanding of ‘real-world’ cystectomy practice. Presentation of data specific to operative modality allows surgeons and centres to benchmark their respective practices. These findings offer to enhance patient and public understanding beyond that currently facilitated by publicly-facing information sources. They carry relevance by describing a near-complete and large volume of modern practice in a publicly funded healthcare system. Level of evidence: 2b
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Affiliation(s)
| | - John Pascoe
- The Royal Devon and Exeter NHS Foundation Trust, UK
| | | | | | | | | | - Rory Bufacchi
- Italian Institute of Technology, Italy
- Department of Neuroscience, Physiology and Pharmacology, University College London (UCL), UK
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Aning JJ, Parry MG, van der Meulen J, Fowler S, Payne H, McGrath JS, Challacombe B, Clarke NW. How reliable are surgeon-reported data? A comparison of the British Association of Urological Surgeons radical prostatectomy audit with the National Prostate Cancer Audit Hospital Episode Statistics-linked database. BJU Int 2021; 128:482-489. [PMID: 33752249 DOI: 10.1111/bju.15399] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate the accuracy and completeness of surgeon-reported radical prostatectomy outcome data across a national health system by comparison with a national dataset gathered independently from clinicians directly involved in patient care. PATIENTS AND METHODS Data submitted by surgeons to the British Association of Urological Surgeons (BAUS) radical prostatectomy audit for all men undergoing radical prostatectomy between 2015 and 2016 were assessed by cross linkage to the National Prostate Cancer Audit (NPCA) database. Specific data items collected in both databases were selected for comparison analysis. Data completeness and agreement were assessed by percentages and Cohen's kappa statistic. RESULTS Data from 4707 men in the BAUS and NPCA databases were matched for comparison. Compared with the NPCA, dataset completeness was higher in the BAUS dataset for type of nerve-sparing procedure (92% vs 42%) and postoperative margin status (89% vs 48%) but lower for readmission (87% vs 100%) and Charlson score (80% vs 100%). For all other variables assessed completeness was comparable. Agreement and data reliability were high for most variables. However, despite good agreement, the inter-cohort reliability was poor for readmission, M stage and Charlson score (κ < 0.30). CONCLUSIONS For the first time in urology we show that surgeon-reported data from the BAUS radical prostatectomy audit can reliably be used to benchmark peri-operative radical prostatectomy outcomes. For comorbidity data, to assist with risk analysis, and longer-term outcomes, NPCA routinely collected data provide a more comprehensive source.
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Affiliation(s)
- Jonathan J Aning
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Matthew G Parry
- London School of Hygiene and Tropical Medicine, London, UK.,Royal College of Surgeons of England, London, UK
| | | | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | | | - John S McGrath
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Ben Challacombe
- Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Noel W Clarke
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
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Gilliland N, Vennam S, Geraghty R, Peacock J, Crockett M, Kearley S, Oxley J, Porter T, Waine E, Aning J, Rowe E, Koupparis A. Surgery for pathological T3a, T3b and lymph node positive, prostate cancer: surgical, functional and oncological outcomes. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820958207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate and document the surgical, functional and oncological outcomes following surgery for high-risk prostate cancer patients. Patients and methods: Patients with pathological T3a, T3b and N1 disease were extracted from our prospectively updated institutional database. Data include demographics, preoperative cancer parameters, short and long-term complications and functional results. Details of biochemical recurrence, type and oncological outcome of salvage treatments, cancer-specific and overall survival were also obtained. Results: A total of 669 patients were included; 58.9% had T3a disease, 35.9% had pT3b and 11.4% N1 disease. With a median follow-up of 66 months (8–129), overall survival was 94.3%, cancer-specific survival was 98.7% and biochemical recurrence was 45.6%. Average inpatient stay was 1 day and the overall complication rate was 9.1%; 54.2% experienced a biochemical recurrence and 90.3% went on to have one or more salvage treatments, which were varied. Significant predictors of biochemical recurrence included pathological stage, any positive margin and patient age ( P<0.005). A total of 44.9% had an immediate biochemical recurrence, with 90% receiving subsequent treatment and 20.5% having a durable response. None of the patients receiving prostate bed radiotherapy alone had a durable response. 54% had a delayed biochemical recurrence, with 63.5% receiving subsequent treatment and 44% having a durable response. Conclusions: Surgery is associated with encouraging surgical and functional outcomes, cancer-specific survival and overall survival rates in these patients. Pathological stage is a significant predictor of biochemical recurrence. The present analysis shows that long-term observation for certain patients with biochemical recurrence is appropriate and questions the effectiveness of further local salvage treatments in patients with an immediate biochemical recurrence postoperatively. Level of evidence: II
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Affiliation(s)
- Niall Gilliland
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | | | - Robert Geraghty
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | | | - Matthew Crockett
- Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, UK
| | | | - Jon Oxley
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | - Tim Porter
- Department of Urology, Yeovil District Hospital, UK
| | | | - Jonathan Aning
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | - Edward Rowe
- The Bristol Urological Institute, North Bristol NHS Trust, UK
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10
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Edison MA, Connor MJ, Miah S, El-Husseiny T, Winkler M, Dasgupta R, Ahmed HU, Hrouda D. Understanding virtual urology clinics: a systematic review. BJU Int 2020; 126:536-546. [PMID: 32463991 DOI: 10.1111/bju.15125] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To perform a systematic review to identify the clinical, fiscal and environmental evidence on the use of urological telehealth and/or virtual clinic (VC) strategies, and to highlight research gaps in this rapidly evolving field. METHODS Our PROSPERO-registered (CRD42019151946) systematic search of Embase, Medline and the Cochrane Review Database was performed to identify original research articles pertaining to adult urology telehealth or VC strategies. Risk-of-bias (RoB) assessment was performed according to the Cochrane 2.0 RoB tool or the Joanna Briggs Institute Checklist for non-randomized studies. RESULTS A total of 5813 participants were included from 18 original articles (two randomized controlled trials [RCTs], 10 prospective studies, six retrospective studies). Urology sub-specialities comprised: uro-oncology (n = 6); general urology (n = 8); endo-urology (n = 2); and lower urinary tract symptoms and/or incontinence (n = 2). Across all sub-specialties, prospective studies using VCs reported a primary median (interquartile range [IQR]) VC discharge rate of 16.6 (14.7-29.8)% and a primary median (IQR) face-to-face (FTF) clinic referral rate of 32.4 (15.5-53.3)%. Direct cost analysis demonstrated median (IQR) annual cost savings of £56 232 (£46 260-£61 116). Grade II and IIIb complications were reported in two acute ureteric colic studies, with rates of 0.20% (3/1534) and 0.13% (2/1534), respectively. The annual carbon footprint avoided ranged from 0.7 to 4.35 metric tonnes of CO2 emissions, depending on the mode of transport used. Patient satisfaction was inconsistently reported, and assessments lacked prospective evaluation using validated questionnaires. CONCLUSION Urology VCs are a promising new platform which can offer clinical, financial and environmental benefits to support an increasing urological referral burden. Further prospective evidence is required across urological sub-specialties to confirm equivalency and safety against traditional FTF assessment.
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Affiliation(s)
- Marie Alexandra Edison
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Martin John Connor
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Imperial Prostate I Department of Surgery and Cancer, Imperial College London, London, UK
| | - Saiful Miah
- Department of Urology, Wycombe Hospital, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Tamer El-Husseiny
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Mathias Winkler
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Imperial Prostate I Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ranan Dasgupta
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Hashim Uddin Ahmed
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.,Division of Surgery, Imperial Prostate I Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Hrouda
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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