Influence of Clinical Parameters and Anticoagulation on Intraprocedural Cerebral Microembolic Signals during Pulmonary Vein Isolation.

Objective: We had the objective to determine the impact of clinical parameters and anticoagulation status on cerebral microembolic signals (MES) during pulmonary vein isolation (PVI) for atrial fibrillation (AF).

Background: Thromboembolism and stroke are the most feared complications of PVI. MES can help to evaluate embolic burden.

Incidence, survival and mortality rates of stage-specific bladder cancer in United States: a trend analysis.

Purpose: To examine the overall and stage-specific age-adjusted incidence, 5-year survival and mortality rates of bladder cancer (BCa) in the United States, between 1973 and 2009.

Materials And Methods: A total of 148,315 BCa patients were identified in the Surveillance, Epidemiology and End Results database, between years 1973 and 2009. Incidence, mortality, and 5-year cancer-specific survival rates were calculated.

Effect of nodal metastases on cancer-specific mortality after cytoreductive nephrectomy.

Background: Relatively few reports have described the outcomes of patients with node-positive renal cell carcinoma (RCC) in the presence of distant metastases. We examined the outcomes of these patients in a large population-based cohort and examined the ability of standard risk factors to predict cancer-specific mortality (CSM).

Methods: Using the Surveillance, Epidemiology, and End Results database, 1415 RCC patients with distant metastases undergoing cytoreductive nephrectomy (CNT) were identified.

Impact of academic affiliation on radical cystectomy outcomes in North America: A population-based study.

Background: : The objective of this study was to examine the rates of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to institutional academic status in patients undergoing radical cystectomy (RC).

Methods: : Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom RC was performed between 1998 and 2007. Multivariable logistic regression analyses were fitted to predict the likelihood of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, and in-hospital mortality.

Pelvic lymph node dissection for prostate cancer: adherence and accuracy of the recent guidelines.

Objectives: The 2004 National Comprehensive Cancer Network practice guidelines recommend pelvic lymph node dissection at radical prostatectomy. We sought to examine the adherence to the 2004 National Comprehensive Cancer Network guidelines and to test the their accuracy, as well as the accuracy of the most contemporary National Comprehensive Cancer Network, American Urological Association, and European Association of Urology guidelines to predict lymph node metastases.

Methods: A total of 33 037 radical prostatectomy patients were identified, between 2004 and 2006.

The effect of gender on nephrectomy perioperative outcomes: a national survey.

Introduction: The effect of gender on complications after surgery is controversial. We examine the effect of gender on five short term nephrectomy outcomes.

Materials And Methods: Within the Health Care Utilization Project, Nationwide Inpatient Sample (NIS) we focused on nephrectomies performed within the most contemporary years (1998-2007).

Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy.

Objective: To test whether cancer control outcomes justify the consideration of partial nephrectomy in patients with large tumors (Stage pT2 or greater) or high-grade tumors (Fuhrman grade III-IV) or lesions extending beyond the kidney (Stage pT3a).

Methods: We abstracted the data for 8847, 11 547, and 5232 patients with tumors >7 cm, Fuhrman grade III-IV, and Stage T3a from the Surveillance, Epidemiology, and End Results database, respectively. All were treated with either partial nephrectomy or radical nephrectomy from 1988 to 2008.

Survival benefit of radical prostatectomy in patients with localized prostate cancer: estimations of the number needed to treat according to tumor and patient characteristics.

Purpose: The benefit of active treatment for prostate cancer is a subject of continuous debate. We assessed the relationship between treatment type (radical prostatectomy vs observation) and cancer specific mortality in a large, population based cohort.

Materials And Methods: We examined the records of 44,694 patients treated with radical prostatectomy or observation between 1992 and 2005 in the SEER (Surveillance, Epidemiology and End Results)-Medicare linked database.

Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: a population-based analysis.

Objectives: To compare the mortality outcomes of radical prostatectomy and radiotherapy as treatment modalities for patients with localized prostate cancer.

Methods: Our cohort consisted of 68 665 patients with localized prostate cancer, treated with radical prostatectomy or radiotherapy, between 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment.

Risk factors for biochemical recurrence following radical perineal prostatectomy in a large contemporary series: a detailed assessment of margin extent and location.

Objectives: The implications of positive surgical margin (PSM) extent and location during radical perineal prostatectomy (RPP) have not been assessed in a contemporary series. We aimed to examine the incidence, location, and extent of PSM as well as their impact on biochemical recurrence (BCR) following RPP.

Materials And Methods: A total of 794 patients underwent RPP by a single surgeon between June 1993 and August 2010.

Variations in the quality of care at radical prostatectomy.

Postoperative morbidity and mortality is low following radical prostatectomy (RP), though not inconsequential. Due to the natural history of the disease process, the implications of treatment on long-term oncologic control and functional outcomes are of increased significance. Structures, processes and outcomes are the three main determinants of quality of RP care and provide the framework for this review.

Annual prostatectomy volume is related to rectal laceration rate after radical prostatectomy.

Objective: To examine the effect of annual prostatectomy volume (APV) on contemporary intraoperative rectal laceration (RL) rates after radical prostatectomy.

Methods: From 1999 to 2008, 36 699 radical prostatectomy procedures were performed in Florida. First, logistic regression models predicting the RL rate were fitted.

Marital status: a gender-independent risk factor for poorer survival after radical cystectomy.

Unlabelled: Study Type - Prognosis (cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Married individuals have lower morbidity and mortality rates for all major causes of death. Cancer-specific survival is better in married patients with testis cancer, prostate cancer, breast cancer, cervical cancer, as well as head and neck cancers.

Discharge patterns after radical cystectomy: contemporary trends in the United States.

Purpose: Discharge patterns, including rates of prolonged length of stay and transfer to a facility, were evaluated in the context of radical cystectomy.

Materials And Methods: Within the Nationwide Inpatient Sample we focused on radical cystectomy performed between 1998 and 2007. Multivariable logistic regression analyses predicting the likelihood of prolonged length of stay or transfer to a facility were performed.

Competing-risks mortality after radiotherapy vs. observation for localized prostate cancer: a population-based study.

Purpose: Contemporary patients with localized prostate cancer (PCa) are more frequently treated with radiotherapy. However, there are limited data on the effect of this treatment on cancer-specific mortality (CSM). Our objective was to test the relationship between radiotherapy and survival in men with localized PCa and compare it with those treated with observation.

Higher perioperative morbidity and in-hospital mortality in patients with end-stage renal disease undergoing nephrectomy for non-metastatic kidney cancer: a population-based analysis.

Unlabelled: What's known on the subject? and What does the study add? Patients with renal failure more frequently harbour RCC due to predisposing factors such as cystic disease of the kidney. The benefit of nephrectomy might be outweighed by adverse perioperative events, however, which may be more prevalent in patients with end-stage renal disease (ESRD). In a population-based study focusing on patients after non-elective colorectal surgery, patients with ESRD had an increased risk of mortality and complications.

Venous thromboembolism after radical prostatectomy: the effect of surgical caseload.

Unlabelled: What's known on the subject? and What does the study add? Several risk factors increase VTE after RP: advanced age, comorbidities such as cardiopulmonary disease, rheumatologic diseases, prior history of VTE, more advanced prostate cancer, and simultaneous pelvic lymph node dissection. To date, the effect of annual surgical caseload (ASC), an established determinant of various RP outcomes, has not been tested. A previous study showed in adjusted analyses that patients operated for colorectal cancer by very high ASC surgeons were 60% less likely to suffer a VTE than those operated by low ASC surgeons.

Blood transfusions in radical prostatectomy: a contemporary population-based analysis.

Objective: To examine the homologous blood transfusion (HBT), autologous blood transfusion (ABT) and intraoperative blood conservation technique (IOBCT) rates and trends at open (ORP) and minimally invasive radical prostatectomy (MIRP).

Methods: The Nationwide Inpatient Sample was queried. Multivariable logistic regression models focused on all three transfusion types.

Prospective randomized trial of barbed polyglyconate suture to facilitate vesico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit.

Unlabelled: Study Type - RCT (randomized trial) Level of Evidence 2b. What's known on the subject? and What does the study add? In a previous randomized controlled trial, barbed polyglyconate suture for vesico-urethral anastomosis was associated with more frequent cystogram leaks, longer mean catheterization times and greater suture costs per case. In the current randomized controlled trial, we show that barbed polyglyconate suture is associated with decreased anastomosis time, decreased need to readjust suture tension, cost reduction, and equal continence and early/late urinary complication rates.

Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample.

Background: Prior to the introduction and dissemination of robot-assisted radical prostatectomy (RARP), population-based studies comparing open radical prostatectomy (ORP) and minimally invasive radical prostatectomy (MIRP) found no clinically significant difference in perioperative complication rates.

Objective: Assess the rate of RARP utilization and reexamine the difference in perioperative complication rates between RARP and ORP in light of RARP's supplanting laparoscopic radical prostatectomy (LRP) as the most common MIRP technique.

Design, Setting, And Participants: As of October 2008, a robot-assisted modifier was introduced to denote robot-assisted procedures.

Hospital volume is a determinant of postoperative complications, blood transfusion and length of stay after radical or partial nephrectomy.

Purpose: We examined the impact of hospital volume on short-term outcomes after nephrectomy for nonmetastatic renal cell carcinoma.

Materials And Methods: Using the Nationwide Inpatient Sample we identified 48,172 patients with nonmetastatic renal cell carcinoma treated with nephrectomy (1998 to 2007). Postoperative complications, blood transfusions, prolonged length of stay and in-hospital mortality were examined.

The effect of annual surgical caseload on the rates of in-hospital pneumonia and other in-hospital outcomes after radical prostatectomy.

Purpose: To examine the effect of annual surgical caseload (ASC) on contemporary in-hospital pneumonia (IHP) rates and three other in-hospital outcomes after radical prostatectomy (RP).

Methods: Between 1999 and 2008, 34,490 open RPs were performed in the state of Florida. First, logistic regression models predicting the rate of IHP were fitted.

Head-to-head comparison of three commonly used preoperative tools for prediction of lymph node invasion at radical prostatectomy.

Objective: A formal validation and head-to-head comparison of the National Comprehensive Cancer Network (NCCN) practice guideline lymph node invasion (LNI) nomogram, Partin tables, and D'Amico risk-classification was conducted for prediction of LNI at radical prostatectomy (RP).

Methods: We focused on 20,877 patients treated with RP and pelvic lymph node dissection (PLND) between 2004 and 2006 within the Surveillance, Epidemiology and End Results database. The discrimination of the 3 tools in predicting histologically confirmed LNI was quantified using the area under the curve (AUC).

Discharge patterns after radical prostatectomy in the United States of America.

Objective: Discharge patterns, including prolonged length of stay (LOS) and adverse discharge disposition (ADD), are important clinical indicators of quality of care. We examined the effect of several indicators on discharge patterns after radical prostatectomy (RP).

Methods: Within the Nationwide Inpatient Sample, we focused on RPs performed between 2001 and 2007.

Node-positive renal cell carcinoma in the absence of distant metastases: predictors of cancer-specific mortality in a population-based cohort.

Unlabelled: Nodal metastases, even in the absence of distant metastases, portend a bad prognosis. The percentage of positive nodes (PPN) represents an important predictor of cancer-specific mortality (CSM) in patients in the group T(any) N(1) M(0) . In consequence, universal inclusion of PPN should be considered in prospective and retrospective CSM analyses.