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Kim AH, Ruel NH, Yamzon J, Zhumkhawala AA, Lau CS, Yuh BE, Chan KG. Indiana Pouch Continent Cutaneous Urinary Diversion After Robotic-assisted Radical Cystectomy: A 16-Year Experience. Urology 2024; 183:e325-e327. [PMID: 37951362 DOI: 10.1016/j.urology.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/19/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Population-based practice patterns in the United States reveal continent diversions are only performed in 8%-10.4% of patients.1-4 Ideally, for patients undergoing radical cystectomy the choice of urinary diversion should be influenced by clinical factors and patient preference, with discussions surrounding quality of life. Unfortunately, receipt of continent diversion has been shown to be influenced by a plethora of other factors such as surgeon preference/training, geography, socioeconomic status, gender, and hospital volume.1-3 Thus, by providing detailed instruction and long-term follow-up, we hope to mitigate some of these disparities by changing the perceptions regarding feasibility and complications of continent diversions. OBJECTIVE To provide step-by-step instruction and to report long-term clinical outcomes in bladder cancer patients receiving an Indiana pouch continent cutaneous urinary diversion (CCUD) after robot-assisted radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS After Institutional Review Board approval, a prospectively maintained bladder cancer database was queried for patients with T1-T4, N0-N1, M0 bladder cancer undergoing radical cystectomy with CCUD at a tertiary referral center from 2004 to 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Complications at 30- and 90-day were recorded according to the Clavien-Dindo classification. Continence rates were recorded by chart review. RESULTS AND LIMITATIONS A total of 97 patients were included with a median follow-up of 93months. Clinically, 91.8% had ≤T2 disease and 29.9% received neoadjuvant chemotherapy. The median length of surgery was 8.0 hours, length of hospital stay was 8.3days, and urinary continence rate was 99.0%. The overall complication rate was 73.2% and 76.5% at 30- and 90-day, respectively. The major complication rate (Clavien III-V) was 17.5% at 30-day and 22.7% at 90-day. The most common major complications were abdominal infection and uretero-colonic stricture. The readmission rate was 21.4% and median overall survival was 108months. CONCLUSION CCUD provides exceptional functional outcomes with acceptable complication rates compared to other diversion types. CCUD is a reliable reconstructive option and with this step-by-step video as a reference, we hope it will be offered to more patients.
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Affiliation(s)
- Albert H Kim
- Louis Stokes Cleveland Veterans Affairs Medical Center, Urology Section, Cleveland, OH
| | - Nora H Ruel
- City of Hope National Medical Center, Division of Biostatistics, Department of Computational and Biostatistics, Duarte, CA
| | - Jonathan Yamzon
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Ali-Ashgar Zhumkhawala
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Clayton S Lau
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Bertram E Yuh
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Kevin G Chan
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA.
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2
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Stetson PD, McCleary NJ, Osterman T, Ramchandran K, Tevaarwerk A, Wong T, Sugalski JM, Akerley W, Mercurio A, Zachariah FJ, Yamzon J, Stillman RC, Gabriel PE, Heinrichs T, Kerrigan K, Patel SB, Gilbert SM, Weiss E. Adoption of Patient-Generated Health Data in Oncology: A Report From the NCCN EHR Oncology Advisory Group. J Natl Compr Canc Netw 2022; 20:jnccn21244. [PMID: 35042190 PMCID: PMC10961646 DOI: 10.6004/jnccn.2021.7088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Collecting, monitoring, and responding to patient-generated health data (PGHD) are associated with improved quality of life and patient satisfaction, and possibly with improved patient survival in oncology. However, the current state of adoption, types of PGHD collected, and degree of integration into electronic health records (EHRs) is unknown. METHODS The NCCN EHR Oncology Advisory Group formed a Patient-Reported Outcomes (PRO) Workgroup to perform an assessment and provide recommendations for cancer centers, researchers, and EHR vendors to advance the collection and use of PGHD in oncology. The issues were evaluated via a survey of NCCN Member Institutions. Questions were designed to assess the current state of PGHD collection, including how, what, and where PGHD are collected. Additionally, detailed questions about governance and data integration into EHRs were asked. RESULTS Of 28 Member Institutions surveyed, 23 responded. The collection and use of PGHD is widespread among NCCN Members Institutions (96%). Most centers (90%) embed at least some PGHD into the EHR, although challenges remain, as evidenced by 88% of respondents reporting the use of instruments not integrated. Forty-seven percent of respondents are leveraging PGHD for process automation and adherence to best evidence. Content type and integration touchpoints vary among the members, as well as governance maturity. CONCLUSIONS The reported variability regarding PGHD suggests that it may not yet have reached its full potential for oncology care delivery. As the adoption of PGHD in oncology continues to expand, opportunities exist to enhance their utility. Among the recommendations for cancer centers is establishment of a governance process that includes patients. Researchers should consider determining which PGHD instruments confer the highest value. It is recommended that EHR vendors collaborate with cancer centers to develop solutions for the collection, interpretation, visualization, and use of PGHD.
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Affiliation(s)
| | | | | | | | - Amye Tevaarwerk
- 5University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Tracy Wong
- 6Seattle Cancer Care Alliance, Seattle, Washington
| | | | - Wallace Akerley
- 8Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
| | | | | | | | - Robert C Stillman
- 10The Ohio State University, James Comprehensive Cancer Center, Columbus, Ohio
| | - Peter E Gabriel
- 11Abramson Cancer Center at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tricia Heinrichs
- 7National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Kathleen Kerrigan
- 8Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
| | - Shiven B Patel
- 8Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
| | | | - Everett Weiss
- 1Memorial Sloan Kettering Cancer Center, New York, New York
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3
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Kim AH, Ruel NH, Yamzon J, Zhumkhawala AA, Lau CS, Yuh BE, Chan KG. Novel Antibiotic-Irrigating Wound Protector Reduces Infectious Complications in Robot-Assisted Radical Cystectomy with Extracorporeal Urinary Diversion. Urology 2021; 159:160-166. [PMID: 34678310 DOI: 10.1016/j.urology.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether use of an antibiotic-irrigating wound protector (AWP) reduces infectious complications after robotic radical cystectomy with extracorporeal urinary diversion (RCUD). METHODS A prospectively maintained bladder cancer database was queried for patients undergoing robotic RCUD at a tertiary referral center one year prior to implementing an AWP and one year after (2018-2020). All diversions were performed extra-corporally. 92 patients total. 46 consecutive patients using a traditional wound protector (TWP) and 46 consecutive with an AWP. Infections were classified as symptomatic urinary tract infection, blood stream infection, and surgical site infection. The incidence of infectious complications at 30- and 90-days were compared. RESULTS Baseline patient characteristics between the 2 groups showed no statistically significant differences. The overall complication rate was 65.2% in the TWP group and 26.1% in the AWP group at 30-days, and 67.4% vs 30.4% at 90-days. Focusing on infections, the 30-day complication rate was 30.4% in the TWP group compared to 6.5% in the AWP group (P =.003). This pattern persisted at 90-days with 37.0% in the TWP group compared to 6.5% in the AWP group (P =.004). Most complications were symptomatic UTI and blood stream infections, 14/24 (58%), requiring parenteral antibiotic treatment. CONCLUSION We provide preliminary data showing use of an AWP can reduce infectious complications after RCUD. While larger prospective studies are warranted, our findings are a significant step towards decreasing morbidity of an already highly morbid procedure.
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Affiliation(s)
- Albert H Kim
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Nora H Ruel
- City of Hope National Medical Center, Division of Biostatistics, Department of Computational and Biostatistics, Duarte, CA
| | - Jonathan Yamzon
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Ali-Ashgar Zhumkhawala
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Clayton S Lau
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Bertram E Yuh
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Kevin G Chan
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA.
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4
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Burg ML, Yamzon J, Li WY. Full thickness penile skin necrosis following HIPEC: Case report and literature review. Urol Case Rep 2020; 34:101430. [PMID: 33088716 PMCID: PMC7558780 DOI: 10.1016/j.eucr.2020.101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 11/04/2022] Open
Abstract
Heated intraperitoneal chemotherapy (HIPEC) is commonly performed at the time of tumor resection for metastatic intraabdominal tumors. Post operative complications, such as superficial wound infections or bowel leaks are common. They are largely thought to be secondary to poor wound healing due to chemotherapy-associated neutropenia. Scrotal eschars resulting in full-thickness skin necrosis have rarely been reported as a delayed complication after HIPEC. Here, we present the first case report of penile full-thickness skin necrosis after abdominal cytoreduction with HIPEC combined with ventral hernia repair and mesh placement.
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Affiliation(s)
- Madeleine L Burg
- Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., Suite 7416, Los Angeles, CA, 90089, USA
| | - Jonathan Yamzon
- Division of Urology, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
| | - Wai-Yee Li
- Division of Plastic and Reconstructive Surgery, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA, 91010, USA
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Gilligan T, Lin DW, Aggarwal R, Chism D, Cost N, Derweesh IH, Emamekhoo H, Feldman DR, Geynisman DM, Hancock SL, LaGrange C, Levine EG, Longo T, Lowrance W, McGregor B, Monk P, Picus J, Pierorazio P, Rais-Bahrami S, Saylor P, Sircar K, Smith DC, Tzou K, Vaena D, Vaughn D, Yamoah K, Yamzon J, Johnson-Chilla A, Keller J, Pluchino LA. Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:1529-1554. [PMID: 31805523 DOI: 10.6004/jnccn.2019.0058] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Testicular cancer is relatively uncommon and accounts for <1% of all male tumors. However, it is the most common solid tumor in men between the ages of 20 and 34 years, and the global incidence has been steadily rising over the past several decades. Several risk factors for testicular cancer have been identified, including personal or family history of testicular cancer and cryptorchidism. Testicular germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes and are categorized into 2 main histologic subtypes: seminoma and nonseminoma. Although nonseminoma is the more clinically aggressive tumor subtype, 5-year survival rates exceed 70% with current treatment options, even in patients with advanced or metastatic disease. Radical inguinal orchiectomy is the primary treatment for most patients with testicular GCTs. Postorchiectomy management is dictated by stage, histology, and risk classification; treatment options for nonseminoma include surveillance, systemic therapy, and nerve-sparing retroperitoneal lymph node dissection. Although rarely occurring, prognosis for patients with brain metastases remains poor, with >50% of patients dying within 1 year of diagnosis. This selection from the NCCN Guidelines for Testicular Cancer focuses on recommendations for the management of adult patients with nonseminomatous GCTs.
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Affiliation(s)
- Timothy Gilligan
- 1Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Daniel W Lin
- 2University of Washington/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | | | | | | | | | - Will Lowrance
- 14Huntsman Cancer Institute at the University of Utah
| | | | - Paul Monk
- 16The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Joel Picus
- 17Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | | | - Daniel Vaena
- 24St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - David Vaughn
- 25Abramson Cancer Center at the University of Pennsylvania
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Chenam A, Chu W, Ruel N, Kilday P, Jamnagerwalla J, Lau C, Zhumkhawala A, Chan K, Yamzon J, Yuh B. MP47-12 COMPARISON OF PERIOPERATIVE OUTCOMES, FUNCTIONAL OUTCOMES, AND COMPLICATIONS FOR ROBOT ASSISTED RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN ELDERLY VS. YOUNG PATIENTS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1491] [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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Chenam A, Yuh B, Zhumkhawala A, Ruel N, Chu W, Lau C, Chan K, Wilson T, Yamzon J. Prospective randomised non-inferiority trial of pelvic drain placement vs no pelvic drain placement after robot-assisted radical prostatectomy. BJU Int 2017; 121:357-364. [DOI: 10.1111/bju.14010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Avinash Chenam
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Bertram Yuh
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Ali Zhumkhawala
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Nora Ruel
- Department of Biostatistics; City of Hope National Medical Center; Duarte CA USA
| | - William Chu
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Clayton Lau
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Kevin Chan
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Timothy Wilson
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Jonathan Yamzon
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
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8
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Chennamsetty A, Zhumkhawala A, Yuh B, Lau C, Chu W, Emtage J, Gellhaus P, Ruel N, Chan K, Yamzon J. PD18-11 PROSPECTIVE RANDOMIZED TRIAL OF PELVIC DRAIN PLACEMENT VERSUS NO PELVIC DRAIN PLACEMENT AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP). J Urol 2017. [DOI: 10.1016/j.juro.2017.02.871] [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: 10/19/2022]
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9
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Chennamsetty A, Chu W, Emtage J, Gellhaus P, Yamzon J, Lau C, Yuh B, Tong T, Colcher D, Wilson T, Zhumkhawala A. PD10-06 INTRA-OPERATIVE OPTICAL IMAGING UTILIZING ANTI-PSMA (PROSTATE SPECIFIC MEMBRANE ANTIGEN) FLUORESCENT ANTIBODY DURING ROBOT ASSISTED RADICAL PROSTATECTOMY (RARP). J Urol 2017. [DOI: 10.1016/j.juro.2017.02.569] [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: 11/28/2022]
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Gin GE, Ruel NH, Parihar JS, Warner JN, Yuh BE, Yamzon J, Wilson TG, Lau CS, Chan KG. Ureteroenteric anastomotic revision as initial management of stricture after urinary diversion. Int J Urol 2017; 24:390-395. [PMID: 28295645 DOI: 10.1111/iju.13323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report our experience with ureteroenteric anastomotic revision as initial treatment of stricture after urinary diversion. METHODS An institutional review board-approved retrospective study was carried out. A total of 41 patients who underwent primary ureteroenteric anastamotic revision were identified between 2007 and 2015. Data analyzed included patient characteristics, type of diversion, estimated blood loss, operative time, change in renal function, length of stay, postoperative complications and time with nephrostomy/stent. Success of revision was defined as an improvement in hydronephrosis on radiographic imaging and/or reflux during pouchogram. Predictors of length of stay and complications were analyzed using analysis of covariance. RESULTS A total of 50 renal units were revised with a success rate of 100%. The median length of stay was 6 days (2-16 days). There were a total of 15 complications (one major, 14 minor) in 14 patients (33% 30-day complication rate). The most common were wound infection (n = 4) and arrhythmia (n = 4). Robotic revision (n = 5) had a median length of stay of 3 days (2-4) with no complications. CONCLUSIONS Primary ureteroenteric anastomotic revisions have an excellent success rate at an experienced center and might obviate the need for multiple interventions. Open revision is associated with mostly minor complications. Robotic revision might reduce the morbidity of open revision in select cases.
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Affiliation(s)
- Greg E Gin
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Nora H Ruel
- Division of Biostatistics, City of Hope National Medical Center, Duarte, California, USA
| | - Jaspreet S Parihar
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jonathan N Warner
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Bertram E Yuh
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jonathan Yamzon
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Timothy G Wilson
- Division of Urologic Oncology, Providence St. John's Health Center, Santa Monica, California, USA
| | - Clayton S Lau
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Kevin G Chan
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
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Kardos SV, Chan KG, Yuh B, Yamzon J, Ruel NH, Zachariah F, Lau CS, Crocitto L. PD02-02 ENHANCED RECOVERY AFTER SURGERY AND CARE COORDINATION PATHWAY AT CITY OF HOPE: DECREASED LENGTH OF STAY, READMISSIONS, AND COMPLICATIONS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2076] [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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12
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Parihar J, Gin G, Lau C, Chan K, Yamzon J. V1-08 PRIMARY ROBOTIC URETEROENTERIC ANASTOMOTIC REVISION IN STUDER NEOBLADDER: OPERATIVE TECHNIQUE AND CASE SERIES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2122] [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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Kardos SV, Chan KG, Yuh BE, Yamzon J, Ruel N, Zachariah F, Lau CS, Crocitto LE. Recovery after surgery and care coordination pathway at City of Hope: Length of stay, readmissions, and complications. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
410 Background: Bladder cancer is the second most common urologic malignancy with over 73,350 new cases diagnosed annually of which the incidence is increasing in the elderly. Radical cystectomy (RC), the gold standard for muscle invasive disease, carries a particularly high risk of morbidity and mortality, as well as a protracted length of stay (LOS) and increased readmission rates when compared with other major urologic procedures. Furthermore, in 2013, the Institute of Medicine (IOM) declared cancer care in the US a national crisis with a priority to improve quality of care through care coordination (CC). Simultaneously, enhanced recovery after surgery (ERAS) protocols have surfaced as coordinated, evidence-based models designed to standardize medical care, improve outcomes, and lower healthcare costs. At City of Hope (COH), we evaluated our ERAS and CC pathway. Methods: In April of 2014, an ERAS and CC pathway for bladder cancer was launched at COH with an emphasis on the perioperative care of patients (pts) from a multi-disciplinary team perspective. Preoperatively, pts undergo orientation on stoma education, goals of care, and treatment expectations. The pathway clinically focuses on avoidance of bowel preparation, early feeding, minimizing narcotics, and u-opioid antagonists. On discharge, pts are closely monitored via scheduled phone calls as well as clinic visits. Quality metrics including LOS, complications, and readmissions are reported as median and interquartile range along with descriptive statistics including chi-square and Wilcoxon rank-sum tests. Results: Since implementation, the median LOS was statistically significant between cohorts with 6 days for pts on pathway compared to 8 days for those preceding the pathway (p = 0.0007). Furthermore, the complication and readmission rates have decreased from 67.5% to 50% and from 35% to 30%, respectively. Dehydration and urinary tract infection (UTI) accounted for 17.9% and 21.4% of readmissions for those prior to the pathway, while UTI occurred in 5% of pts readmitted after adhering to the pathway. Conclusions: Our ERAS and CC pathway has reduced LOS without an increase in complication nor readmission rates.
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Bourque J, Chan K, Wilson T, Lau C, Yuh B, Yamzon J, Zachariah F, Crocitto L. MP64-08 ESTABLISHING A CARE COORDINATION PATHWAY FOR BLADDER CANCER CYSTECTOMY PATIENTS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2319] [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: 11/15/2022]
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15
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Zhumkhawala A, Tirughana-Sambandan R, Mooney R, Berlin J, Aboody K, Yamzon J. MP61-03 NEURAL STEM CELLS AND GOLD NANOPARTICLES AS NOVEL TREATMENT FOR PROSTATE CANCER – EARLY IN VITRO STUDIES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2184] [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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16
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Zhumkhawala A, Tirughana-Sambandan R, Mooney R, Berlin J, Aboody K, Yamzon J. MP49-17 NEURAL STEM CELLS AND GOLD NANOPARTICLES AS NOVEL TREATMENT FOR BLADDER CANCER – EARLY IN VITRO STUDIES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2812] [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: 11/28/2022]
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17
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Yuh B, Torrey RR, Ruel NH, Wittig K, Tobis S, Linehan J, Lau CS, Chan KG, Yamzon J, Wilson TG. Intermediate-Term Oncologic Outcomes of Robot-Assisted Radical Cystectomy for Urothelial Carcinoma. J Endourol 2014; 28:939-45. [DOI: 10.1089/end.2014.0073] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bertram Yuh
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Robert R. Torrey
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Nora H. Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kristina Wittig
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Scott Tobis
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jennifer Linehan
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Clayton S. Lau
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kevin G. Chan
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jonathan Yamzon
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Timothy G. Wilson
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
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Wittig K, Yamzon J, Smith D, Lau C, Kawachi M, Wilson T, Smith S. MP74-11 PRE-SURGICAL EXPRESSED PROSTATIC SECRETION BIOMARKER PERFORMANCE IN THE DETECTION OF GLEASON UPGRADING IN PROSTATE CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2344] [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: 11/30/2022]
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Nazmy M, Wilson T, Yuh B, Lau C, Yamzon J, Torrey R, Linehan J, Ruel N, Chan K. 1761 COMPLICATIONS OF ROBOTIC ASSISTED RADICAL CYSTECTOMY BY DIVERSION TYPE. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2890] [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: 10/27/2022]
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Pal SK, Yamzon J, Sun V, Carmichael C, Saikia J, Ferrell B, Frankel P, Hsu J, Twardowski P, Stein CA, Margolin K. Paclitaxel-based high-dose chemotherapy with autologous stem cell rescue for relapsed germ cell tumor: clinical outcome and quality of life in long-term survivors. Clin Genitourin Cancer 2012; 11:121-7. [PMID: 23062817 DOI: 10.1016/j.clgc.2012.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/30/2012] [Accepted: 09/13/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-dose chemotherapy (HDCT) is a viable and potentially curative approach for patients with relapsed or refractory germ cell tumors (GCTs). However, no comparative data exist to define the optimal chemotherapeutic strategy, and little is known about the quality of life (QOL) of long-term survivors. Herein we attempt to characterize the QOL in long-term survivors who received high-dose paclitaxel, etoposide, carboplatin, and ifosfamide (TECTIC). PATIENTS AND METHODS Details of the TECTIC regimen and clinical outcomes for the initial 33 patients have been reported. In the present study, we report the clinical data for 15 additional patients. Using the European Organization for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and the Functional Assessment of Cancer Therapy-Taxane (FACT-T) questionnaires, we surveyed all patients who survived at least 4 years after HDCT. RESULTS Forty-eight patients were enrolled and 46 patients received protocol therapy. For all 48 patients, the median progression-free survival (PFS) and overall survival (OS) were 11.8 months (range, 5.8-not reached) and 21.7 months (range, 12.7-not reached), respectively. Seventeen patients were progression free at a median of 123.2 months (51.6-170.2 months), and 6 patients remain alive after progression with a median OS of 68.8 months (47.6-147.1 months). Of the 23 surviving patients, 18 were accessible and consented to telephone interviews. Compared with historical cohorts, survivors had a higher global health scale score (87.04 vs. 75.62; P = .02) but a lower physical functioning score (68.89 vs. 92.66; P = .0001) by the QLQ-C30 scale. CONCLUSIONS HDCT with the TECTIC regimen produces durable remissions in patients with relapsed or refractory GCTs with acceptable QOL in long-term survivors.
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Affiliation(s)
- Sumanta K Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Nazmy M, Yuh B, Chan K, Lau C, Yamzon J, Linehan J, Torrey R, Kawachi M, Wilson T. 1760 PERIOPERATIVE COMPLICATIONS OF ROBOTIC RADICAL CYSTECTOMY AND URINARY DIVERSION WITHIN 90 DAYS OF SURGERY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1776] [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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Yamzon J, Ruel N, Yuh B, Torrey R, Whelan C, Linehan J, Lau C, Wilson T, Josephson D. 659 LAPAROSCOPIC AND ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY IN CLINICALLY HIGH-RISK LOCALIZED PROSTATE CANCER AT A SINGLE INSTITUTION. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1575] [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: 10/18/2022]
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Yamzon J, Lee KH, Kuremoto KI, Choi IS, Parsa S, Bellusci S, Warburton D, Koh C. 1372 FGF-10/FGFR2B SIGNALING DURING ACUTE CYCLOPHOSPHAMIDE-INDUCED BLADDER UROTHELIAL INJURY IN MICE. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chung S, Kang DO, Yamzon J, Warburton D, Koh CJ. O-GlcNAc mediated glycosylation down-regulation in mice with cyclophosphamide induced cystitis. J Urol 2010; 183:351-6. [PMID: 19914650 DOI: 10.1016/j.juro.2009.08.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Indexed: 01/05/2023]
Abstract
PURPOSE Cyclophosphamide induced cystitis is an established model for the study of bladder injury and wound healing. Glycosylation is an important modification mechanism that regulates the structure and function of secreted proteins and growth factors from inflammation sites. We determined the effect of cyclophosphamide induced cystitis on O-GlcNAc mediated glycosylation in the bladder. MATERIALS AND METHODS Cystitis in WT C57BL6 mice was induced with intraperitoneal cyclophosphamide. Retrieved bladders were analyzed using histology, immunohistochemistry, reverse transcriptase-polymerase chain reaction and Western blot for glycosylation associated factors. RESULTS Acute bladder injury was seen up to 168 hours (7 days) after injection. Reverse transcriptase-polymerase chain reaction revealed down-regulation of O-GlcNAc transferase, a key enzyme in O-GlcNAc mediated glycosylation, at the 8, 48 and 168-hour time points. Also, the glycosidase menangioma expressed antigen 5 was up-regulated at similar time points. Western blot analysis revealed decreased glycosylated protein during cyclophosphamide induced inflammation. CONCLUSIONS To our knowledge we report the first study of alterations in O-GlcNAc mediated glycosylation activity in bladders with cyclophosphamide induced cystitis. Glycosylation may have a significant role in the bladder wound healing process. Future studies of the glycosylation signaling pathways in the bladder would assist in future potential therapy for bladder inflammatory disease and cancer by elucidating pathways that guide bladder development and wound healing.
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Affiliation(s)
- Seyung Chung
- Developmental Biology, Regenerative Medicine and Surgery Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
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Chung SS, Kang DO, Hsu KT, Kokorowski P, Yamzon J, Perin L, De Filippo R, Jones P, Warburton D, Atala A, Koh CJ. FIBROBLAST GROWTH FACTOR 10-MEDIATED DIFFERENTIATION OF HUMAN AMNIOTIC FLUID STEM CELLS INTO UROTHELIAL CELLS BY CO-CULTIVATION WITH HUMAN BLADDER CANCER CELLS. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yamzon J, Chung S, Kang DO, Kokorowski P, Kuremoto KI, Koh CJ. FIBROBLAST GROWTH FACTOR 10-MEDIATED DELAY IN BLADDER WOUND HEALING IN INDUCIBLE TRANSGENIC MICE. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yamzon J, Kokorowski P, De Filippo RE, Chang AY, Hardy BE, Koh CJ. Pediatric robot-assisted laparoscopic excision of urachal cyst and bladder cuff. J Endourol 2008; 22:2385-8; discussion 2388. [PMID: 18937602 DOI: 10.1089/end.2008.0338] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Urachal cysts are the most common urachal anomaly in the pediatric population. There is an increasing body of literature documenting successful management of urachal cysts using laparoscopic techniques. There may be an advantage, however, with the use of robot-assisted laparoscopy for reconstructive cases. We describe the techniques used for robot-assisted laparoscopic excision of a urachal cyst and bladder cuff with bladder repair in a female child. This approach is a safe and effective option for the minimally invasive management of pediatric urachal cysts.
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Affiliation(s)
- Jonathan Yamzon
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, and Division of Pediatric Urology, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA
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Quek ML, Nichols PW, Yamzon J, Daneshmand S, Miranda G, Cai J, Groshen S, Stein JP, Skinner DG. Radical cystectomy for primary neuroendocrine tumors of the bladder: the university of southern california experience. J Urol 2005; 174:93-6. [PMID: 15947585 DOI: 10.1097/01.ju.0000162085.20043.1f] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Primary neuroendocrine tumors of the bladder are rare and they include small and large cell variants. We reviewed our experience with treating these tumors with radical cystectomy to evaluate their histopathological characteristics and clinical outcomes. MATERIALS AND METHODS From August 1971 to June 2004, 2,005 patients underwent radical cystectomy for primary bladder cancer at our institution, of whom 25 (1.2%) had neuroendocrine tumors of the bladder, including small cell carcinoma in 20 and large cell carcinoma in 5. Pure neuroendocrine-type histology was identified in 16 cases, including 1 with small and large cell features, while the remaining 9 had mixed histology, that is transitional cell carcinoma in 8 and adenocarcinoma in 1. Multi-agent chemotherapy was administered to 14 patients. RESULTS Median patient age was 68 years (range 40 to 82) and 19 patients were male (76%). A total of 19 patients (76%) had lymph node involvement, of whom 2 had small liver metastases found intraoperatively, while only 4 (16%) had organ confined tumors and 2 (8%) had extravesical, node negative disease. These tumors tended to have a flat, ulcerative gross appearance with lymphovascular invasion, carcinoma in situ and necrosis present microscopically. Median followup was 11.8 years (range 18 days to 15.1 years). Five-year overall and recurrence-free survival was 10% and 13%, respectively. There was no significant survival difference between small and large cell carcinoma. Mixed histologies tended to do better than pure neuroendocrine tumors, although this did not attain statistical significance (p = 0.064). Patients receiving multimodality therapy had significantly better overall (p = 0.051) and recurrence-free (p = 0.003) survival than those treated with cystectomy alone. CONCLUSIONS Neuroendocrine tumors of the bladder usually present with advanced pathological stage and portend a poor prognosis. Adjuvant chemotherapy protocols may provide improved survival compared with cystectomy alone.
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Affiliation(s)
- Marcus L Quek
- Departments of Urology, Keck School of Medicine, University of Southern California, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California, USA.
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