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Kaldany A, Blum KA, Paulucci DJ, Beksac AT, Jayaratna I, Sfakianos JP, Badani KK. An evaluation of race, ethnicity, age, and sex-based representation in phase I to II renal cell carcinoma clinical trials in the United States. Urol Oncol 2018; 36:363.e1-363.e6. [DOI: 10.1016/j.urolonc.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/06/2018] [Accepted: 05/08/2018] [Indexed: 11/16/2022]
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Falagario UG, Beksac AT, Cumarasamy S, Xu P, Martini A, Gupta A, Mahajan K, Jayaratna I, Tewari A. PD60-04 DEFINING A FAVORABLE INTERMEDIATE-RISK GROUP: UTILITY OF MAGNETIC RESONANCE IMAGING AND GENETIC TESTS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Beksac AT, Falagario U, Cumarasamy S, Gupta A, Xu P, Prasad S, Martini A, Thulasidass H, Jayaratna I, Rastinehad A, Tewari A. MP14-17 ROLE OF MAGNETIC RESONANCE IMAGING IN PREDICTING ADVERSE PATHOLOGY POST-RADICAL PROSTATECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reddy JP, Pettaway CA, Levy LB, Pagliaro LC, Tamboli P, Rao P, Jayaratna I, Hoffman KE. Factors associated with regional recurrence after lymph node dissection for penile squamous cell carcinoma. BJU Int 2016; 119:591-597. [PMID: 27753187 DOI: 10.1111/bju.13686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify factors associated with regional recurrence after lymph node dissection (LND) for squamous cell carcinoma (SCC) to determine which patients might benefit from adjuvant therapy. PATIENTS AND METHODS Men who underwent LND for penile SCC from 1977 to 2014 were identified from an institutional database. Kaplan-Meier curves estimated recurrence-free survival (RFS) calculated from the date of LND. Cox regression models evaluated the association between RFS and patient and tumour characteristics. RESULTS In all, 182 men who underwent LND for penile SCC were identified. The median patient age was 62 years and the median follow-up was 4.2 years. After LND 34 men had regional recurrence, of which 24 developed isolated regional recurrences without distant metastasis. The median RFS was 5.7 months, and the 3-year RFS rate was 70%. On univariate analysis, lymphovascular invasion, clinical and pathological nodal stage, pathological inguinal laterality, pelvic nodal involvement, lymph node density ≥5.2%, ≥3 pathologically involved lymph nodes, and extranodal extension (ENE) were associated with worse RFS (all P < 0.05). On multivariate analysis, clinical N3 disease [adjusted hazard ratio (AHR)] 3.53, 95% confidence interval (CI) 1.68-7.45; P = 0.001), ≥3 pathologically involved lymph nodes (AHR 3.78, 95% CI 2.12-6.65; P < 0.001), and ENE (AHR 3.32, 95% CI 1.93-5.76; P < 0.001) were associated with worse RFS. The 3-year RFS for patients with cN0, cN1, cN2, and cN3 disease was 91.7%, 64.5%, 54.7%, and 38.3%, respectively. For men with ≥3 involved nodes, the 3-year RFS was 17% vs 82.4% in men with <3 involved nodes. The 3-year RFS was 29.7% in men with ENE and 85.7% in men without ENE. CONCLUSION The presence of clinical N3 disease, ≥3 pathologically involved lymph nodes, and ENE was associated with worse RFS. As regional recurrence portends a dismal prognosis with few salvage options, adjuvant therapies should be developed for men with the aforementioned adverse factors.
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Affiliation(s)
- Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lawrence B Levy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Pheroze Tamboli
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya Rao
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isuru Jayaratna
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Jayaratna I, Matin S, Pettaway C. V1-04 ROBOTIC ASSISTED INGUINAL LYMPHADENECTOMY FOR PENILE CANCER: THE MD ANDERSON CANCER CENTER TECHNIQUE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jayaratna I, Porten S, Roth B, Cheng T, Melquist J, Choi W, Pretzsch S, Bondaruk J, Guo C, Czerniak B, McConkey D, Dinney C. PI-06 TCF21, A NOVEL METASTASIS SUPPRESSOR, PROMOTES THE ACQUISITION OF A LUMINAL PHENOTYPE IN HUMAN BLADDER CANCER. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Borofsky MS, Gill IS, Hemal AK, Marien TP, Jayaratna I, Krane LS, Stifelman MD. Near-infrared fluorescence imaging to facilitate super-selective arterial clamping during zero-ischaemia robotic partial nephrectomy. BJU Int 2012; 111:604-10. [PMID: 23253629 DOI: 10.1111/j.1464-410x.2012.11490.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There is concern that warm ischaemia time during partial nephrectomy may have an adverse impact on postoperative renal function. As a result, there is increased interest in developing a safe and effective method for performing non-ischaemic partial nephrectomy. Several novel approaches have recently been described. We present our initial experience performing zero-ischaemia partial nephrectomy using near-infrared fluorescence imaging to facilitate super-selective arterial clamping. We report the operative and early postoperative outcomes from such cases as compared with a matched cohort of patients undergoing traditional partial nephrectomy with clamping of the main renal artery. We show that this technique is both safe and effective and may lead to improved renal preservation at short-term follow-up. OBJECTIVE To describe a novel technique of eliminating renal ischaemia during robotic partial nephrectomy (RPN) using near-infrared fluorescence (NIRF) imaging. PATIENTS AND METHODS Over an 8-month period (March 2011 to November 2011), 34 patients were considered for zero-ischaemia RPN using the da Vinci NIRF system. Targeted tertiary/higher-order tumour-specific branches were controlled with robotic bulldog(s) or neurosurgical aneurysm micro-bulldog(s). Indocyanine green dye was given, and NIRF imaging used to confirm super-selective ischaemia, defined as darkened tumour/peri-tumour area with green fluorescence of remaining kidney. Matched pair analysis was performed by matching each patient undergoing zero-ischaemia RPN (n = 27) to a previous conventional RPN (n = 27) performed by the same surgeon. RESULTS Of 34 patients, 27 (79.4%) underwent successful zero-ischaemia RPN; seven (20.6%) required conversion to main renal artery clamping (ischaemia time <30 min) for the following reasons: persistent tumour fluorescence after clamping indicating inadequate tumoral devascularization (n = 5), and parenchymal bleeding during RPN (n = 2). Matched-pair analysis showed comparable outcomes between cohorts, except for longer operating time (256 vs 212 min, P = 0.02) and superior kidney function (reduction of estimated glomerular filtration rate (-1.8% vs -14.9%, P = 0.03) in the zero-ischaemia cohort. All surgical margins were negative. CONCLUSIONS In this pilot study, we show that zero-ischaemia RPN with NIRF is a safe alternative to conventional RPN with main renal artery clamping. Eliminating global ischaemia may improve functional outcomes at short-term follow-up.
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Affiliation(s)
- Michael S Borofsky
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
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Fairey A, Daneshmand S, Jayaratna I, Skinner E, Schuckman A, Cai J, Lieskovsky G. 1325 LONG-TERM OUTCOMES OF RADICAL PROSTATECTOMY FOR PT3BN0M0 PROSTATE CANCER IN THE PROSTATE SPECIFIC ANTIGEN SCREENING ERA. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Perkin H, Jayaratna I, Kim P, Eisenberg M, Loh-Doyle J, Gill I, Desai M. V402 A LAPAROSCOPIC APPROACH FOR MANAGEMENT OF A LEFT RENAL CELL CARCINOMA WITH RENAL VEIN THROMBUS. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Goh A, Hung A, Jayaratna I, Teruya K, Patil M, Dunn M, Gill I. 861 EXTERNAL VALIDITY OF STANDARDIZED TASKS FOR EVALUATION AND TEACHING OF ROBOTIC TECHNICAL SKILLS. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leslie S, Abreu ALDC, Lewandowski PM, Huang EYH, Berger AK, Jayaratna I, Nakamoto M, Ng C, Ukimura O, Aron M, Gill IS, Desai MM. V398 ROBOTIC ZERO-ISCHEMIA PARTIAL NEPHRECTOMY FOR HILAR TUMORS. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fairey A, Daneshmand S, Faber K, Jayaratna I, Lee D, Schuckman A, Lieskovsky G, Cai J, Miranda G, Skinner E. 1411 PREDICTION OF SURVIVAL OUTCOMES AFTER RADICAL CYSTECTOMY USING THREE COMORBIDITY INDICES: A PROPOSAL FOR A STANDARDIZED INSTRUMENT. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jayaratna I, Munver R, Disick G, Han MW, Sawczuk I. Paraneoplastic hypertension associated with renal oncocytoma: management with cryoablation. Urology 2008; 73:209.e9-11. [PMID: 18372030 DOI: 10.1016/j.urology.2008.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 01/23/2008] [Accepted: 02/07/2008] [Indexed: 11/18/2022]
Abstract
Paraneoplastic hypertension associated with a renal oncocytoma is an unreported syndrome. We report a unique case of a patient with multidrug-resistant hypertension who was found to have a solitary renal mass. Cryoablation was performed and resulted in an immediate and dramatic decrease in blood pressure. Histologic review of intraoperative biopsy specimens revealed findings consistent with renal oncocytoma. To our knowledge, this is the first report of hypertension in the setting of a renal oncocytoma, with subsequent improvement of this paraneoplastic syndrome after cryoablation.
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Affiliation(s)
- Isuru Jayaratna
- University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA
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