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Impact of surgical management of upper tract urothelial cancer in octogenarians:A population-based study

Current Urology 2024年第3期18卷 225-231页

作者： Shu Wang Michael Phelan mohummad minhaj siddiqui Division of Urology Department of SurgeryUniversity of Maryland School of MedicineBaltimoreMDUSA Veterans Affairs Maryland Healthcare System BaltimoreMDUSA

Background Upper tract urothelial carcinoma(UTUC)is an aggressive disease with a high progression *** standardmanagement for this disease is *** sparing nonradical surgery is an alternative therapeutic *** men with limited life expectancy,the potential harm of UTUC progression must be weighed against surgical morbidity and mortality,and thus,more conservative approaches may be *** study aims to investigate the comparative benefits of radical and conservative surgical management in patients older than 80 years with localized *** and methods A search was conducted in the Surveillance,Epidemiology,and End Results database for patients older than 80 years who were diagnosed with localized(T1–2N0M0)cancer in the renal pelvis or ureter as the only malignancy from 2004 to *** were divided into 3 therapeutic groups:no surgery,local intervention(ie,local tumor excision or segmented ureterectomy),and radical surgery(nephroureterectomy).Demographic and cancer-related parameter data were *** regression analysis was conducted to investigate predictors for surgical ***-Meier curves and Cox regression were used to analyze survival *** Data from 774 patients were analyzed,including 205 in the no-surgery group,181 in the local intervention group,and 388 in the radical surgery ***,African American patients with T1 stage disease were less likely to receive surgical *** surgically treated patients,renal pelvic tumors,and high-grade and T2 stage disease were associated with radical *** treated patients had a longer median overall survival(OS)than in those treated nonsurgically(13,35,and 47 months in no-surgery,local intervention,and radical surgery groups,respectively;p<0.001).Although surgically treated patients demonstrated higher 5-year OS(8.8%[no surgery],23.2%[local intervention],and 23.5%[radical surgery],p<0.001)and 5-year disease-specif

关键词： Older adults Surgery Surveillance,Epidemiology,and End Results Survival Upper tract urothelial carcinoma

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Determining the component-based operative time learning curve for robotic-assisted radical prostatectomy

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Current Urology 2022年第4期16卷 240-245页

作者： David Ambinder Shu Wang mohummad minhaj siddiqui Division of Urology Department of SurgeryUniversity of Maryland School of MedicineBaltimoreMDUSA

Objectives:To determine the learning curve(LC)of total operative time and the discrete components of the robotic-assisted radical prostatectomy(RARP)for a recent robotic fellowship-trained urologic *** and methods:We performed a retrospective analysis of RARP procedures performed by a single new attending surgeon from August 2015 to April ***'demographics and operative details were *** operative time was divided and prospectively recorded in 7 parts:(a)docking robot,(b)dissecting seminal vesicles(SVs)(c)dissecting endopelvic fascia(EPF),(d)incising bladder neck(BN),(e)completing the dissection,(f)lymph node dissection,and(g)urethrovesical anastomosis(UVA)and robot *** sum analysis was used to ascertain the LC for total operative time and the 7 parts of the ***:One hundred twenty consecutive RARPs were *** LC was overcome at 25 cases for total operative time,13 cases for docking the robot,33 cases for dissecting SVs,31 cases for dissecting EPF,46 cases for incising BN,38 cases for prostate dissection,25 cases for lymph node dissection,and 52 cases for *** operative time was decreased 22.8%(p<0.0001)and time for robot docking,dissecting SVs,dissecting EPF,incising BN,completing prostate dissection,lymph node dissection,and UVA were decreased 16.7%,30.5%,29.5%,36.2%,37.3%,32.2%,and 26.9%,respectively(all p<0.05).Conclusions:We observed a 25-case LC for a fellowship-trained urologist to achieve stable operative performance of RARP *** components demonstrated variable LCs including the UVA that required upward of 52 cases.

关键词： Cumulative sum(CUSUM)analysis Learning curve Prostate cancer Robotic-assisted radical prostatectomy

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Learning curve for magnetic resonance imaging/ultrasound fusion prostate biopsy in detecting prostate cancer using cumulative sum analysis

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Current Urology 2023年第3期17卷 159-164页

作者： Linhan Xu Nancy Yating Ye Adrianna Lee Jasleen Chopra Michael Naslund Jade Wong-You-Cheong Amelia Wnorowski mohummad minhaj siddiqui University of Maryland School of Medicine BaltimoreMDUSA Division of Urology Department of General SurgeryKaiser Permanente Los Angeles Medical CenterLos AngelesCAUSA Department of Diagnostic Radiology University of Maryland School of MedicineBaltimoreMDUSA Division of Urology Department of SurgeryUniversity of Maryland School of MedicineUniversity of Maryland Medical CenterBaltimoreMDUSA

Background:Targeted magnetic resonance(MR)with ultrasound(US)fusion-guided biopsy has been shown to improve detection of prostate *** implementation of this approach requires integration of skills from radiologists and *** methods for assessment of learning curves,such as cumulative sum(CUSUM)analysis,may be helpful in identifying the presence and duration of a learning *** aim of this study is to determine the learning curve for MR/US fusion-guided biopsy in detecting clinically significant prostate cancer using CUSUM *** and methods:Retrospective analysis was performed in this institutional review board-approved *** urologists implemented an MR/US fusion-guided prostate biopsy program between March 2015 and September *** primary outcome measure was cancer detection rate(CDR)stratified by Prostate Imaging Reporting and Data System(PI-RADS)scores assigned on the MR *** sum analysis quantified actual cancer detection versus a predetermined target satisfactory CDR of MR/US fusion biopsies in a sequential case-by-case *** this analysis,satisfactory performance was defined as>80%CDR in patients with Pl-RADS 5,>50%in PI-RADS 4,and<20%in Pl-RADS ***:Complete data were available for MR/US fusion-guided biopsies performed on 107 *** CUSUM learning curve analysis demonstrated intermittent underperformance until approximately 50 *** this inflection point,there was consistently good performance,evidence that no further learning curve was being ***:At a new center implementing MR/US fusion-guided prostate biopsy,the learning curve was approximately 50 cases before a consistently high performance for prostate cancer detection.

关键词： Cumulative sum analysis Learning curve Magnetic resonance/ultrasound fusion biopsy Prostate cancer

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