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Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

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Asian Journal of Urology 2024年第1期11卷 72-79页

作者： Vanessa A.Lukas Rahul Dutta Ashok K.Hemal matvey tsivian Timothy E.Craven Nicholas A.Deebel David D.Thiel Ram Anil Pathak Brigham and Women's Hospital Division of UrologyDepartment of Surgery75 Francis StreetBostonMAUSA Atrium Health Wake Forest Baptist Medical Center Department of Urology1 Medical Center BlvdWinston-SalemNCUSA Mayo Clinic Florida Department of Urology4500 San Pablo RoadJacksonvilleFLUSA

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 ***:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were *** analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical ***:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were *** and multivariable analysis exhibited similar *** LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant *** hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant ***:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program *** the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

关键词： Minimally-invasive partial nephrectomy The American College of Surgeons National Surgical Quality Improvement Program Lengthof stay Hospital readmission

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Castration-resistant prostate cancer： a strategy to enhance response to androgen deprivation

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Asian Journal of Andrology 2013年第6期15卷 709-710页

作者： Yuri Stanevsky Alexander tsivian matvey tsivian Department of Urologic Surgery The E. Wolfson Medical Center Helen and Sackler school of Medicine Tel Aviv University Tel Aviv 53000 Israel Division of Urology Department of Surgery Duke University Medical Center Durham NC 27710 USA

Anew research study evaluated the mechanisms of prostate cancer （PCa）resistance to androgen deprivation therapy （ADT） and progression to castrate-resistant disease. Using a codinical approach, the investigators were able to identify key gen-etic determinants of ADT resistance, gain insight into the molecular pathways that play a key role in this transition and pro-pose a potential management strategy to overcome ADT resistance in select cancers. This represents a step forward towards per-sonalized medicine guided by specific molecular markers of prostate cancer enab-ling more effective therapies targeted towards altered metabolic pathways.

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Combined cryotherapy and external beam radiation therapy for the treatment of intermediate-risk localized prostate cancer: A case series

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Case Reports in Clinical Medicine 2014年第1期3卷 47-51页

作者： Peter Qi matvey tsivian Zeljko Vujaskovic Thomas J. Polascik Department of Radiation Oncology Duke University Medical Center Durham USA Division of Urology Department of Surgery Duke University Medical Center Durham USA

Introduction: Routine PSA screening for prostate cancer (PCa) has increased the detection of intermediate-risk, localized disease. Conventional treatments for localized PCa include surgery, brachytherapy, cryotherapy or external beam radiotherapy (EBRT). However, for intermediate risk patients, rates of recurrence are moderately high and a multi-modal treatment approach for these patients may be necessary. We treated patients with a combination of cryotherapy and low dose EBRT to assess the safety and feasibility of this combinatory approach as well as to evaluate early oncological outcomes. Case Presentation: Men with intermediate risk (PSA = 10-20 ng/ml and/or Gleason = 7 and/or clinical T2b) localized PCa were prospectively enrolled in this study. Patients underwent cryotherapy and then 39 Gy EBRT 4-6 weeks after surgery. After completing EBRT, the men were followed every 3 months for 2 years. Adverse events, PSA, urinary and erectile function were assessed during each follow-up. Three patients completed the study. Preoperative PSA ranged from 3.5 to 7.9 ng/ml. There were no intraoperative complications and the treatment was well tolerated. Following cryotherapy and EBRT, all patients were pad-free within 6 months and remained continent for the duration of the study. Bother index remained stable throughout the study for all patients. No urethral strictures or rectal toxicities were observed. PSA remained undetectable for all patients. Conclusions: In this prospective study, cryotherapy combined with low dose EBRT was a safe approach for the treatment of intermediate-risk, localized PCa. Early oncological outcomes appeared to be favorable with all patients having undetectable PSA during the 2-year follow-up period. Further studies are warranted to confirm these preliminary results.

关键词： External Beam Radiation Cryotherapy Localized Prostate Cancer Intermediate Risk

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