Inguinal lymph node dissection in the era of minimally invasive surgical technology.
Melanoma; Penile cancer; Endoscopic; Inguinal lymph nodes; Inguinal lymphadenectomy; Minimally invasive; Robotic; Video-assisted; Vulvar cancer
Background: Inguinal lymph node dissection (ILND) is an essential step in both treatment and staging of several malignancies including penile and vulvar cancers. Various open, video endoscopic, and robotic-assisted techniques have been utilized so far. In this review, we aim to describe available minimally invasive surgical approaches for ILND, and review their outcomes and complications.; Methods: The PubMed, Wiley Online Library, and Science Direct databases were reviewed in February 2020 to find relevant studies published in English within 2000-2020.; Findings: There are different minimally invasive platforms available to accomplish dissection of inguinal nodes without jeopardizing oncological results while minimizing postoperative complications. Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy are safe and achieve the same nodal yield, a surrogate metric for oncological adequacy. When compared to open technique, Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy may offer faster postoperative recovery and fewer postoperative complications including wound dehiscence, necrosis, and infection. The relatively high rate and severity of postoperative complications hinders utilization of recommended ILND for oncologic indications. Minimally invasive approaches, using laparoscopic or robotic-assisted platforms, show some promise in reducing the morbidity of this procedure while achieving adequate short and intermediate term oncological outcomes. (Copyright © 2020 Elsevier Inc. All rights reserved.)
Nabavizadeh R;Petrinec B;Nabavizadeh B;Singh A;Rawal S;Master VA
Urologic Oncology
2020
2020-08-25
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.urolonc.2020.07.026" target="_blank" rel="noreferrer noopener">10.1016/j.urolonc.2020.07.026</a>
Outcomes in patients with renal cell carcinoma undergoing inferior vena cava ligation without reconstruction versus thrombectomy: A retrospective, case-controlled study.
inferior vena cava (IVC); functional outcomes; ligation; renal cell carcinoma (RCC); thrombectomy
Purpose: Radical nephrectomy with tumor thrombectomy is considered standard of care in patients with renal cell carcinoma (RCC). Surgical ligation and interruption of the inferior vena cava (IVC), however, is sometimes necessary when the tumor thrombus invades the IVC wall. This study assesses the outcomes in patients with RCC undergoing IVC ligation compared to IVC thrombectomy.; Methods: We conducted a case-controlled, retrospective study at a high-volume single-center institution. All RCC patients who underwent ligation without reconstruction were matched with thrombectomy patients in a 1:2 ratio based on pre-operative renal function, RCC stage, and intraoperative thrombus level. Endpoints were complications, change in renal function, and mortality.; Results: 26 RCC patients who underwent IVC ligation between 2005 and 2019 were matched with 52 patients who underwent IVC thrombectomy in the same time period. When compared to thrombectomy, ligation patients had higher 90-day readmission rate (19% vs 4%, p = 0.025). The ligation group also had a higher postoperative complication rate (73% vs 39%, p = 0.004) and higher rates of lymphedema (23% vs 8%, p = 0.055) . However, by 1-month follow-up, the rate of persistent overall and major complications for both ligation and thrombectomy groups were comparable; 49% vs 31% ( p = 0.497) 8% vs 8% ( p = 1.000), respectively. Importantly, at 18-month follow up, mean eGFR declines were similar between ligation patients (8.5 mL/min/1.73m 2 ) and thrombectomy patients (9.9 mL/min/1.73m 2 ) ( p = 0.834). Differences in cancer-specific mortality ( p = 0.993 ) and all-cause mortality ( p = 0.756) were also not statistically significant.; Conclusions: The outcomes of IVC ligation compared to IVC thrombectomy for RCC are similar. IVC ligation patients initially face a more complicated postoperative course, but in the longer term, have similar renal function recovery, complication rates, and survival.
Xie L;Hong G;Nabavizadeh R;Patil D;Ethun CG;Ogan K;Maithel SK;Master VA
The Journal Of Urology
2020
2020-09-09
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journalArticle
<a href="http://doi.org/10.1097/ju.0000000000001354" target="_blank" rel="noreferrer noopener">10.1097/ju.0000000000001354</a>
Segmentation and linear measurement for body composition analysis using slice-o-matic and horos.
Body composition is associated with risk of disease progression and treatment complications in a variety of conditions. Therefore, quantification of skeletal muscle mass and adipose tissues on Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) may inform surgery risk evaluation and disease prognosis. This article describes two quantification methods originally described by Mourtzakis et al. and Avrutin et al.: tissue segmentation and linear measurement of skeletal muscle. Patients' cross-sectional image at the midpoint of the third lumbar vertebra was obtained for both measurements. For segmentation, the images were imported into Slice-O-Matic and colored for skeletal muscle, intramuscular adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue. Then, surface areas of each tissue type were calculated using the tag surface area function. For linear measurements, the height and width of bilateral psoas and paraspinal muscles at the level of the third lumbar vertebra are measured and the calculation using these four values yield the estimated skeletal muscle mass. Segmentation analysis provides quantitative, comprehensive information about the patients' body composition, which can then be correlated with disease progression. However, the process is more time-consuming and requires specialized training. Linear measurements are an efficient and clinic-friendly tool for quick preoperative evaluation. However, linear measurements do not provide information on adipose tissue composition. Nonetheless, these methods have wide applications in a variety of diseases to predict surgical outcomes, risk of disease progression and inform treatment options for patients.
Steele S; Lin F; Le Thien-Linh; Medline A; Higgins M; Sandberg A; Evans S; Hong G; Williams MA; Bilen MA; Psutka S; Ogan K; Master VA
2021
2021-03-21
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>