Apparent diffusion coefficient values obtained by unenhanced MRI predicts disease-specific survival in bladder cancer.

AIM: To assess the ability of apparent diffusion coefficient (ADC) measurements obtained by MRI to predict disease-specific survival (DSS) in patients with bladder cancer and compare it with established clinico-pathological prognostic factors. MATERIAL AND METHODS: The ethical review board approved this cross-sectional study. Patients with suspected bladder cancer receiving diagnostic 3 T diffusion-weighted imaging (DWI) of the bladder before transurethral resection of the bladder (TUR-B) or radical cystectomy were evaluated prospectively. Two independent radiologists measured ADC values in bladder cancer lesions in regions of interest. Associations between ADC values and pathological features with DSS were tested statistically. A combined model was established using artificial neuronal network (ANN) methodology. RESULTS: A total of 51 patients (median age 69 years, range 41-89 years) were included. Three patients were lost to follow-up, leaving 48 patients for survival analysis. Seven patients died during the 795 months studied. ADC showed significant potential to predict DSS (p<0.05). Except for grading, all pathological features as assessed by TUR-B could predict DSS (p<0.05, respectively). The combined ANN classifier showed the highest accuracy to predict DSS (0.889, 95% confidence interval: 0.732-1, p=0.001) compared to all single parameters. ADC was the second important predictor of the ANN. CONCLUSIONS: ADC measurements obtained by unenhanced MRI predicts DSS in bladder cancer patients. A combined classifier including ADC and clinico-pathological information showed high accuracy to identify patients at high risk for disease-related death.

[Hemodynamic effects of cafedrine/theodrenaline on anesthesia-induced hypotension]. / Hämodynamisches Wirkungsspektrum von Cafedrin/Theodrenalin bei Anästhesie-assoziierter Hypotension.

BACKGROUND: There is insufficient knowledge about the hemodynamic effects of cafedrine/theodrenaline (caf/theo), a commercially available drug combination, to treat hypotension. METHODS: This prospective observational study investigated the hemodynamic effects of caf/theo on anesthesia-induced hypotension in 20 patients scheduled for elective major abdominal surgery. After induction of total intravenous anesthesia (TIVA) with propofol and remifentanil, a decrease in mean arterial blood pressure (MAP) below 60 mm Hg (n = 12) was treated with 60 mg/3 mg caf/theo. The systemic vascular resistance index (SVRI), cardiac index (CI), global end-diastolic index (GEDI), maximum pressure increase in the aorta (dPmx) and global ejection fraction (GEF) were assessed by transpulmonary thermodilution (PiCCO2-Monitor). RESULTS: The MAP increased by approximately 60% 10 min after administration of caf/theo. The increase in MAP was a result of the simultaneous effects on various cardiovascular determinants. An increase in peripheral resistance (SVRI +42%) and CI (+17%) could be determined. Data further indicated that the increase in CI was a consequence of an increase in both dPmx (+31%) and GEDI (+9%) but the GEF remained constant. CONCLUSION: In anesthesia-induced hypotension caf/theo effectively increased the mean arterial blood pressure by combined effects on preload, contractility, and afterload without altering cardiovascular efficiency.

The use of mannitol in partial and live donor nephrectomy: an international survey.

PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN. MATERIALS AND METHODS: A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures. RESULTS: Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection. CONCLUSIONS: A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.

Nocturia: an Austrian study on the multifactorial etiology of this symptom.

AIMS: To identify the different factors contributing to nocturia in a clinical setting. PATIENTS AND METHODS: Three hundred twenty-four patients (133 women, 191 men; mean age 63 years) were entered into this multi-institutional study. When presenting with nocturia we obtained detailed medical history and performed urine analysis, post-void residual volume and renal ultrasonography. Bothersome score and quality of life were evaluated using visual analogue scale and Kings' Health Questionnaire (KHQ), respectively. Patients were asked to complete a 48-hr voiding diary (VD). Nocturia and its associated problems were evaluated using KHQ and VD in conjunction with concurrent health variables. RESULTS: Mean nocturia was 2.8 in men versus in 3.1 women. Fifty percent of patients were aged >65 years, 60% had daytime lower urinary tract symptoms (LUTS) as well as nocturia, 33% had cardiac pathologies and 7% had peripheral edema. Principal causes for nocturia were global polyuria in 17%, nocturnal polyuria (NP) in 33% and reduced functional capacity <250 ml in 16.2%; 21.2% had mixed forms of NP and reduced bladder capacity and 12.6% suffered from other causes. Mean bothersome score was higher in women (P < 0.001) and in patients with NP (P = 0.012). Quality of life was significantly lower in women (P = 0.001), in patients aged >65 years (P = 0.029) and in those with reduced functional capacity (P < 0.001). Mean voided 24-hr urine was higher in women (P = 0.033) and in patients aged <65 years (P = 0.019). CONCLUSIONS: Nocturia had a high impact on bothersome score, strong associations with poor health and other LUTS. NP was the predominant cause of nocturia. Neurourol. Urodynam. 28:427-431, 2009. (c) 2009 Wiley-Liss, Inc.

[Energy ablative therapy of renal tumours]. / Energieablative Therapie von Nierentumoren.

Solid renal tumours with a diameter <4 cm may be effectively cured by partial nephrectomy but this is associated with a complication rate of 15-20%. In addition, these tumours are more frequently diagnosed in the elderly (<70 years) and 26% are aggressive G3 and potentially hazardous tumours. Since these tumours are frequently unifocal, spherical, peripherally located and easily accessible for minimally invasive approaches, energy ablative techniques are attractive less invasive therapeutic options. These tumours may be treated by freezing (cryoablation) or by heat (radiofrequency ablation, high intensified focused ultrasound). Cryoablation seems to be the most reliable technique with a 1.6% recurrence rate over 3 years follow-up but only 1.8% complications. Conversely skipping renders RFA unreliable in highly vascularised tumours >3 cm with 23% vital tumours to be found at histological work-up. Laparoscopic HIFU is still experimental. Percutaneous techniques are less effective as compared with laparoscopy with recurrence rates ranging between 13-21% (cryoablation) and 14-18% (RFA). In addition, oncological follow-up relies solely on radiological measurements, frequently without histological verification thus making percutaneous techniques unpredictable.

Local intratumoral tumor necrosis factor-alpha and systemic IFN-alpha 2b in patients with locally advanced prostate cancer.

To examine tolerability and activity of local, intratumoral tumor necrosis factor-alpha (TNF-alpha) and systemic interferon-alpha2b (IFN-alpha2b) in locally advanced, hormone-resistant prostate cancer (LA-HRPC), 10 patients with LA-HRPC (T4N x M0, n = 3, T4N x M1, n = 5; T4N1M1, n = 2) were treated with recombinant TNF-alpha injected locally into prostate tumor tissue at 4-week intervals (maximum of four cycles) combined with intermittent subcutaneous (s.c.) administration of 5 x 10(6) IU IFN-alpha2b. Twenty-nine TNF-alpha cycles were administered. Despite significant TNF-alpha leakage into the systemic circulation 2 h after intraprostatic application (from a mean of 9 to a mean of 416 pg/ml; p = 0.0034), TNF-alpha (and IFN-alpha2b) was well tolerated (WHO grade 1-2 toxicity), possibly because of its rapid neutralization by increasing soluble 55-kDa and 75-kDa TNF receptor levels in the serum (mean increase 268% and 91%, respectively) at the same time. TNF-alpha induced prostate tumor cell necrosis in all patients, leading to a significant reduction of prostate volume in 9 of 10 cases (mean 38%; p = 0.0025). The significant short-term increase of prostate-specific antigen (PSA) (mean 65%; p < 0.001), tissue polypeptide-specific antigen (TPS) (mean 85%; p = 0.001), and possibly interleukin-8 (IL-8) (mean 2687%; p < 0.009) serum levels within 4 h after TNF-alpha confirmed the cytotoxic effect in vivo. In the long term, serum PSA levels dropped by 18%-87%, reaching the nadir value 7 weeks after baseline. Objective responses of metastases were not seen. Intraprostatic administration of TNF-alpha is feasible at a tolerable toxicity in patients with LA-HRPC and, thus, may be a new treatment option for these patients.

Serum dehydroepiandrosterone sulfate concentrations in men with erectile dysfunction.

OBJECTIVES: In 1994, the Massachusetts Male Aging Study presented the finding of an inverse correlation of the serum levels of dehydroepiandrosterone sulfate (DHEAS) and the incidence of erectile dysfunction (ED). Prompted by the positive results of a pilot study on the treatment of ED with dehydroepiandrosterone (DHEA), we performed a detailed investigation on the serum DHEAS levels in men with ED according to age category. METHODS: Inclusion criteria included a history of ED for more than 6 months, a body mass index less than 30, and a state of good general health. Serum DHEAS concentrations were determined in 309 patients with ED and 133 healthy volunteers. All participants were carefully screened to assess medical factors known or suspected to alter endocrine function. Questions 3 and 4 of the International Index of Erectile Function were used to evaluate erectile function. RESULTS: The mean serum levels of DHEAS in patients with ED were lower than in healthy volunteers until 60 years of age. The shape of the curve of the patients with ED indicated a quadratic decrease of DHEAS with age in contrast to a more linear decrease of DHEAS with age in the control group. CONCLUSIONS: Our results suggest that until the age of 60 years, the mean serum level of DHEAS is lower in patients with ED than in healthy volunteers.

Skills of lay people in checking the carotid pulse.

American Heart Association as well as European Resuscitation Council require the carotid pulse check to determine pulselessness in an unconscious victim and to decide whether or not cardiopulmonary resuscitation (CPR) should be initiated. Recent studies on the ability of health professionals to check the carotid pulse have called this diagnostic tool in question and led to discussions. To contribute to this discussion we performed a study to evaluate skills of lay people in checking the carotid pulse. A group of 449 volunteers (most had participated in a first aid course) were asked to check the carotid pulse in a young healthy, non-obese person by counting aloud the detected pulse rate. Time intervals until correct detection of the carotid pulse were registered. Overall the volunteers needed an average of 9.46 s, ranging from 1 to 70 s. Only 47.4% of the volunteers were able to detect a pulse within 5 s, and 73.7% within 10 s. A level of 95% volunteers detecting the pulse correctly was reached only after 35 s. Based on these findings we conclude that the intervals established for carotid pulse check may be too short and that perhaps the value of pulse check within in the scope of CPR needs to be reconsidered.

ACD versus standard CPR in a prehospital setting.

BACKGROUND: Animal and human studies in cardiac arrest demonstrate significant improvements in systolic blood pressure, coronary perfusion pressure and total brain and myocardial blood flow with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR). The results of recent studies in patients with out-of-hospital cardiac arrest and use of ACD-CPR are non-uniform and require supplementation. METHODS: In a retrospective non-randomised design, 152 adult patients with prehospital cardiac arrest, not caused by trauma or hypothermia, were studied. Compressions were performed according to the recommendations of the American Heart Association. Three ACD devices were assigned to seven rescue units changing monthly. Study end-points were the rates of return of spontaneous circulation (ROSC), admission to hospital, survival at 24h, hospital discharge and neurologic outcome. RESULTS: 70 (46%) patients underwent standard (STD) CPR and 82 (54%) patients were treated with ACD-CPR. Both groups were comparable with regard to age, sex, witnessed cardiac arrests, bystander CPR, cause of arrest, time intervals, number of defibrillations, and total amount of epinephrine. No significant differences in outcome could be found: 20 patients (29%) who received STD-CPR, and 14 patients (17%) who underwent ACD-CPR survived to hospital discharge. Neither at other end-points nor in any subgroups could any significant differences be discovered. Patients regaining ROSC showed a significant difference in favour of STD-CPR for the end-points of hospital admission, 24-h survival and hospital discharge. CONCLUSION: No significant differences in hospital discharge and neurological outcome were found between STD-CPR and ACD-CPR.

Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study.

UNLABELLED: In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany--defibrillation by emergency physicians (EPs)-in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians: control group? METHODS: Prior to the onset of the study, all EMTs completed retraining in basic life support (BLS). Randomly assessed EMTs were then trained to use semi-automatic defibrillators. With the help of on-line tape recordings, the complete resuscitation sequence was evaluated. Follow-up of the patients was carried out with the help of the Glasgow Coma Scale as well as Pittsburgh Cerebral and Overall Performance Categories. RESULTS: A total of 159 patients with VF were included in the study. In 121 cases, collapse was witnessed. Of the patients receiving defibrillation by EMTs 25% were discharged from hospital alive, compared to 24% of the patients defibrillated by EPs. Of the study patients 67% were defibrillated within 12 min, while the percentage of control patients was 46%. Study patients were defibrillated earlier (P < 0.01), the return of spontaneous circulation (ROSC) was achieved earlier (P < 0.05), and the rate of patients requiring no adrenalin during resuscitation was higher in the study group (P < 0.05). The total amount of adrenalin administered in the study group was lower (P < 0.05). No statistically significant differences were found concerning the neurologic long-term prognosis. CONCLUSIONS: In our study, EMT defibrillation was equally effective as defibrillation by EPs, but failed to improve survival rates or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to a reduction in the time intervals from collapse to defibrillation and to ROSC, as well as in adrenalin doses, by EMT-defibrillation, EMTs in Germany should defibrillate if they reach a patient prior to an EP, provided they have received continuous medical training and supervision.

Expression of the hMSH6 mismatch-repair protein in colon cancer and HeLa cells.

PRINCIPLES: 10 to 15% of human colon cancers are associated with an inherited or somatic defect of the DNA Mismatch Repair (MMR) system, which has evolved to correct biosynthetic errors such as nucleotide mis-incorporations or misalignments arising during DNA replication in the S phase of the cell-cycle. Although expression of the MMR genes was expected to be cell-cycle dependent, we and others observed that the MMR proteins hMSH2 and hMLH1 are expressed constitutively in proliferating cells. METHODS: In this study we extend our observations to another essential MMR protein, hMSH6. We used immunohistochemistry to evaluate the expression pattern of this protein in human colorectal mucosa and tumours, as well as in synchronised HeLa-S3 cells, in which we analysed its steady-state levels during the cell-cycle. RESULTS: We show that the immunohistochemical pattern of expression of hMSH6 in normal colorectal crypts and in colon cancers differs significantly from that of the other MMR proteins, with a much lower percentage of replicating cells being hMSH6-positive. This implies that hMSH6 could be cell-cycle regulated. In order to test this hypothesis in a model system, we synchronised HeLa-S3 cells with mitotic shake-off and found that the hMSH6 protein was detectable throughout the cell-cycle, but that its steady-state level increased when cells progressed from G1 to S-phase. DISCUSSION: The increase of hMSH6 steadystate level when cells enter S-phase was expected, since MMR acts during DNA replication. However, the overall low level of oscillations of hMSH6 during the cell-cycle in this cellular model apparently does not fit the immunohistochemical phenotype. We believe that this discrepancy is due to the fact that human cell lines proliferate at a much higher rate than normal and neoplastic colorectal cells in vivo.

[Submucous mucous membrane support in intrinsic sphincter insufficiency. A therapeutic approach in female stress incontinence]. / Submuköse Schleimhautunterfütterung bei intrinsischer Sphinkterinsuffizienz. Ein Therapieanatz bei weiblicher Stressinkontinenz.

Urethral bulking agents are an attractive alternative for treating patients with intrinsic sphincter deficiency (ISD), i.e., type III urinary stress incontinence. These endoscopic techniques are minimally invasive and can be used in high-risk patients. As bulking agents, Teflon, autologous fat, collagen, silicone particles, and detachable microballoons have been the object of considerable clinical research. Teflon forms granulomas in the surrounding tissue and tends to migrate and is now considered obsolete. More recently, human collagen, autologous cartilage, Bioglass, and hyaluronic acid with dextranomer and polycarbon particles have come under clinical investigation, but long-term results are still lacking. The optimal bulking agent should be nondegradable and biologically inert and should not migrate or change its bulking capability. To date, there is no consensus on the best agent fulfilling these requirements, but encapsulated substances appear most promising.

Magnetic resonance imaging-guided prostate biopsy: institutional analysis and systematic review.

OBJECTIVES: To evaluate the detection rate of prostate cancer (PCa) after magnetic resonance-guided biopsy (MRGB); to monitor the patient cohort with negative MRGB results and to compare our own results with other reports in the current literature. MATERIALS AND METHODS: A group of 41 patients was included in this IRB-approved study and subjected to combined MRI and MRGB. MRGB was performed in a closed 1.5 T MR unit and the needle was inserted rectally. The follow-up period ranged between 12 and 62 months (mean 3.1 years). To compare the results with the literature, a systematic literature search was performed. Eighteen publications were evaluated. RESULTS: The cancer-suspicious regions were punctured successfully in all cases. PCa was detected in eleven patients (26.9 %) who were all clinically significant. MRGB showed a benign histology in the remaining 30 patients. In the follow-up (mean 3.1 years) of patients with benign histology, no new PCa was diagnosed. The missed cancer rate during follow-up was 0.0 % in our study. CONCLUSION: MRGB is effective for the detection of clinically significant cancer, and this is in accordance with the recent literature. In the follow-up of patients with benign histology, no new PCa was discovered. Although the probability of developing PCa after negative MRGB is very low, active surveillance is reasonable.

Utility and limitations of 3-Tesla diffusion-weighted magnetic resonance imaging for differentiation of renal tumors.

OBJECTIVE: To investigate utility and limitations of 3-Tesla diffusion-weighted (DW) magnetic resonance imaging (MRI) for differentiation of benign versus malignant renal lesions and renal cell carcinoma (RCC) subtypes. MATERIALS AND METHODS: Sixty patients with 71 renal lesions underwent 3 Tesla DW-MRI of the kidney before diagnostic tissue confirmation. The images were retrospectively evaluated blinded to histology. Single-shot echo-planar imaging was used as the DW imaging technique. Apparent diffusion coefficient (ADC) values were measured and compared with histopathological characteristics. RESULTS: There were 54 malignant and 17 benign lesions, 46 lesions being small renal masses ≤ 4 cm. Papillary RCC lesions had lower ADC values (p=0.029) than other RCC subtypes (clear cell or chromophobe). Diagnostic accuracy of DW-MRI for differentiation of papillary from non-papillary RCC was 70.3% resulting in a sensitivity and specificity of 64.3% (95% CI, 35.1-87.2) and 77.1 (95% CI, 59.9-89.6%). Accuracy increased to 83.7% in small renal masses (≤ 4 cm diameter) and sensitivity and specificity were 75.0% and 88.5%, respectively. The ADC values did not differ significantly between benign and malignant renal lesions (p=0.45). CONCLUSIONS: DW-MRI seems to distinguish between papillary and other subtypes of RCCs especially in small renal masses but could not differentiate between benign and malignant renal lesions. Therefore, the use of DW-MRI for preoperative differentiation of renal lesions is limited.

Circulating angiostatin, bFGF, and Tie2/TEK levels and their prognostic impact in bladder cancer.

OBJECTIVE: To assess the role and prognostic significance of angiostatin, basic fibroblast growth factor (bFGF), and tyrosine endothelial kinase (TEK/Tie2) in transitional cell bladder carcinoma. MATERIALS AND METHODS: Angiostatin, bFGF, and TEK serum concentrations were measured in 82 bladder cancer patients and 20 age-matched healthy controls using enzyme-linked immunosorbent assay. Results were compared with clinicopathologic and follow-up data with the Mann-Whitney U test and Kaplan-Meier, univariate and multivariate Cox regression analyses. RESULTS: We found significantly decreased angiostatin and TEK serum levels and mildly elevated bFGF concentrations in samples of bladder cancer patients compared with controls (P < .001, P < .001, and P = .083, respectively). Furthermore, high TEK serum levels were correlated with poor disease-specific and metastasis-free survival in muscle-invasive bladder cancer (P = .013, P = .018), whereas angiostatin and bFGF concentrations did not show any correlation with patients' prognosis. Multivariate analysis revealed high TEK levels (<1.60 ng/mL) as borderline significant independent risk-factor of disease-specific survival (HR 1.83, 95% CI 0.97-3.44, P = .061) and metastasis-free survival (HR 2.65, 95% CI 0.93-7.55, P = .069). CONCLUSION: The characteristic differences in the circulating levels of angiostatin, TEK, and bFGF between patients and controls, suggest the presence of a tumor-induced proangiogenic milieu in bladder cancer. Serum TEK levels may contribute to a more reliable preoperative risk stratification in muscle-invasive bladder cancer and therefore may help to optimize therapeutic decisions.

Focal therapy and imaging in prostate and kidney cancer: renal biopsy protocols before and after focal therapy.

There is a continuous increase in incidentally diagnosed small renal masses, with a predominant rise in the elderly and frail population, making less invasive energy ablative therapy strategies more desirable. The decision for treatment and follow-up strategies, however, are commonly based on sequential radiologic CT or MRI investigations only. In small renal masses, up to 30% benign tumors may be found, not necessitating any treatment. Likewise, all currently available energy ablative techniques must be compared with respect to safety and efficacy; this is only possible by histologic definition of the treated target. Finally, not only for academic reasons, the malignant entity of the treated mass must be known for further follow-up investigations, especially when insufficient ablation is suggested during follow-up-suggested by lack of shrinkage and persisting contrast enhancement on CT or MRI. Therefore, liberal use of renal mass biopsy (Bx) is mandatory before any focal therapy. There is some role for intraoperative biopsy in selected cases and for study purposes. Conversely, the role of postfocal therapy Bx protocols remains unclear but seems at least mandatory in lesions that are seemingly insufficiently treated during follow-up. This article gives an overview of Bx protocols suggested in the literature and obtained by personal experience in the continuous use of several energy ablative techniques.

Perioperative morbidity of laparoscopic cryoablation of small renal masses with ultrathin probes: a European multicentre experience.

BACKGROUND: Low morbidity has been advocated for cryoablation of small renal masses. OBJECTIVES: To assess negative perioperative outcomes of laparoscopic renal cryoablation (LRC) with ultrathin cryoprobes and patient, tumour, and operative risk factors for their development. DESIGN, SETTING, AND PARTICIPANTS: Prospective collection of data on LRC in five centres. INTERVENTION: LRC. MEASUREMENTS: Preoperative morbidity was assessed clinically and the American Society of Anaesthesiologists (ASA) score was assigned prospectively. Charlson Comorbidity Index (CCI) and Charlson-Age Comorbidity Index (CACI) scores were retrospectively assigned. Negative outcomes were prospectively recorded and defined as any undesired event during the perioperative period, including complications, with the latter classed according to the Clavien system. Patient, tumour, and operative variables were tested in univariate analysis as risk factors for occurrence of negative outcomes. Significant variables (p<0.05) were entered in a step-forward multivariate logistic regression model to identify independent risk factors for one or more perioperative negative outcomes. The confidence interval was settled at 95%. RESULTS AND LIMITATIONS: There were 148 procedures in 144 patients. Median age and tumour size were 70.5 yr (range: 32-87) and 2.6 cm (range: 1.0-5.6), respectively. A laparoscopic approach was used in 145 cases (98%). Median ASA, CCI, and CACI scores were 2 (range: 1-3), 2 (range: 0-7), and 4 (range: 0-11), respectively. Comorbidities were present in 79% of patients. Thirty negative outcomes and 28 complications occurred in 25 (17%) and 23 (15.5%) cases, respectively. Only 20% of all complications were Clavien grade > or = 3. Multivariate analysis showed that tumour size in centimetres, the presence of cardiac conditions, and female gender were independent predictors of negative perioperative outcomes occurrence. Receiver operator characteristic curve confirmed the tumour size cut-off of 3.4 cm as an adequate predictor of negative outcomes. CONCLUSIONS: Perioperative negative outcomes and complications occur in 17% and 15.5%, respectively, of cases treated by LRC with multiple ultrathin needles. Most of the complications are Clavien grade 1 or 2. The presence of cardiac conditions, female gender, and tumour size are independent prognostic factors for the occurrence of a perioperative negative outcome.