The Comprehensive Complication Index. Proposed modification to improve estimates of perioperative morbidity after radical cystectomy. A pilot study.

INTRODUCTION: The aim of this article was to compare the 30-day morbidity after radical cystectomy comparing the prevalent Clavien-Dindo Classification (CDC) and the novel Comprehensive Complication Index (CCI). Additionally, we evaluated the correlation between particular clinical features and the severity of perioperative morbidity. MATERIAL AND METHODS: A total of 42 patients were included into the study (33 men and 9 women) who underwent open radical cystectomy (RC) with bilateral lymphadenectomy for bladder cancer. The selection of complications was based on groundbreaking research on morbidity after RC. The assessment of perioperative complications was performed using the CDC and then the CCI. RESULTS: The CCI was found to be a significant upgrade in capturing cumulative morbidity in comparison to the CDC when used as the only evaluational tool. CONCLUSIONS: Using only the CDC may underestimate the severity of perioperative complications. Unfavorable clinical features e.g. older age, chronic kidney disease (CKD), persistent nodal (pN+) disease, prior abdominal and pelvic surgeries as well as smoking are of significant importance for the increase of the severity of perioperative complications.

Is ERCC1 a prognostic biomarker for urothelial cancer following radical cystectomy? A long-term analysis.

INTRODUCTION: Excision repair cross-complementation 1 protein (ERCC1) plays a vital role in cancer cells enabling DNA repair via nucleotide excision repair. Thus, we hypothesized whether expression of this protein may be utilized as a prognostic marker in patients after radical cystectomy. MATERIAL AND METHODS: The final analysis involved 123 patients with urothelial bladder carcinoma who underwent radical cystectomy with bilateral lymphadenectomy. The median follow-up time was equal to 853 days. ERCC1 status was evaluated immunohistochemically with the application of tissue microarrays. RESULTS: Positive ERCC1 expression was noted in 46% of the studied cases. Among the analyzed clinical and pathological factors, we could not establish a statistically significant correlation with ERCC1. Similarly, survival curves were statistically indifferent in patients with tumors categorized according to both expression categories. We did not confirm a prognostic value of ERCC1 in the multivariate regression analysis. CONCLUSIONS: ERCC1 expression does not influence the overall survival of patients with urothelial bladder carcinoma after radical cystectomy.

A complex case of abdominal pain in a patient with pelviureteric junction obstruction.

Pelviureteric junction (PUJ) obstruction is a condition frequently encountered in both adult and pediatric patients. Congenital abnormalities and crossing lower-pole renal vessels are the most common underlying pathologies in both men and women. This report presents a case of a young woman who was complaining of intermittent abdominal pain in whom right-sided hydronephrosis was diagnosed. The patient was scheduled for a laparoscopic right-sided Anderson-Hynes pyeloplasty. During the procedure a partly extraperitoneal appendix, with extensive adhesions to the posterior abdominal wall abutting on the ureter just below the obstructed PUJ, was identified. The patient underwent dismembered laparoscopic Anderson-Hynes pyeloplasty with concurrent appendectomy for likely dual pathologies being responsible for her symptoms.

[Serum levels of 25(OH)D3 in patients with prostate cancer compared to healthy men]. / Ocena steienia 25(OH)D3 w grupie chorych z rakiem prostaty w porównaniu do grupy zdrowych mezczyzn.

UNLABELLED: Prostate cancer (CaP) is one of the most common cancers in men. On the basis of international and Polish epidemiological data it is estimated that is the second leading cause of death from cancer. These data tend to look for underlying causes such a high incidence. Detected in 1990, the relationship between UV radiation and the reduction of mortality rate due to CaP gave rise to the search for effects of vitamin D, in CaP. The aim of this study was to evalu ate the concentration of 25(OH)D3 in patients treated for prostate cancer (CaP) compared to the control group of healthy men, and attempt to assess the relationship 25(OH)D3 shortage of CaP incidence and degree of its clinical advancement. MATERIAL AND METHODS: The study included 42 men, aged from 42 to 86 years (average age 66.14+/-8.92 years) treated between 2005-2013 in sCO due to prostate cancer. The control group consisted of 40 healthy men aged from 42 to 78 years (average age 63.17+/-9.02) in whom CaP and other cancer disease were excluded. Patients treated for CaP were divid ed into two groups depending on the severity of the cancer being evaluated by the TNM scale. Group 1 consisted of 11 patients with low severity of CaP-T1, group 2 -31 patients with higher tumor stage (T2+T3+T4). In all patients, serum 25(OH)D3 was marked in venous blood collected in the morning. RESULTS: The concentration of 25(OH)D3 in the group of patients with CaP occured in 80.94. There was no statistically significant difference between patients 25(OH)D3 concentra tions of CaP and control group (p = 0.3756). In both subgroups of patients with CaP showed no statistically significant difference 25(OH)D3 concentra tions (p = 0.5672), depending on the tumor advancement stage (according to TNM). CONCLUSIONS: The majority of tested patients with prostate cancer were low concentrations of vitamin D3. There were no significant differences in concentrations of vitamin D3 in the group of patients with CaP and in the control group. Based on the analysis no relationship between the 25(OH)D3 concentration and the stage of CaP was showed, too.

Lymph node dissection during laparoscopic (LRC) and open (ORC) radical cystectomy due to muscle invasive bladder urothelial cancer (pT2-3, TCC).

AIM: The aim of the study was to compare the number of nodes dissected during laparoscopic and open radical cystoprostatectomy in men or anterior exenteration in women due to muscle invasive bladder urothelial cancer (IBC). MATERIAL AND METHODS: Fifty-one patients treated with laparoscopic radical cystectomy (LRC) and 63 with open radical cystectomy (ORC) were compared. The LRC group consisted of 47 pT2 tumours and 4 pT3, while the ORC group was composed of 27 pT2 tumours and 36 pT3. During ORC external, internal, common iliac and obturator lymph nodes were removed separately, but were added and analysed together for each side. Nodes dissected from one side during ORC were compared to en bloc dissected nodes in the LRC group. RESULTS: There were no complications associated with extended pelvic lymph node dissection during LRC or ORC. There were significant differences in the mean number of resected lymph nodes between LRC and ORC for pT2 tumours. The laparoscopic approach allowed about 8-9 more lymph nodes to be removed than open surgery in the pT2 group. In 15% of patients with pT2 disease treated with open radical cystectomy node metastases were observed. Active disease was detected in 18% of nodes resected laparoscopically due to pT2 disease. Fourty-seven percentage of patients with pT3 disease treated with open surgery were diagnosed as harbouring metastatic lymph nodes. The laparoscopic group with pT3 disease was too small to analyse. CONCLUSIONS: We have found that laparoscopic radical cystectomy can be performed without any compromise in lymph node dissection. The technique of lymph node dissection (LND) during laparoscopic cystectomy (LRC) resulted in sufficient resected lymphatic tissue, especially in patients with bladder-confined tumours with a low volume of lymph nodes.

Is pure laparoscopic radical cystectomy still an attractive solution for the treatment of muscle-invasive bladder cancer?

OBJECTIVE: The aim of this study is to report our experience with laparoscopic radical cystectomy (LRC), evaluating the technique and perioperative and pathological outcomes. METHODS: 47 LRCs were performed due to muscle-invasive bladder cancer. Conduits were performed in 23 patients and neobladders in 23 (one bi-intestinal). One ureterocutaneostomy was created. RESULTS: In 43 patients LRC was performed with minilaparotomy for urinary diversion. The mean operation time was 290 min. Four operations were converted. Complications included sigmoid colon injury, urinary leak, lymphatic leak, short-term paralytic ileus, and heart attack. Mean blood loss was 220 ml. Hospitalization time was 6 days. Tumor stage was pT2b, pT3a, pT3b, and pT4a in 28, 13, 5, and 1 patient, respectively. No positive margins were found. The mean number of lymph nodules was 17, while in the last 25 procedures it was 21. 17% of patients had tumor in the lymph nodes. The mean follow-up was 10 months. Local recurrence and dissemination was observed in 2%. Continence in patients receiving neobladder was fully satisfactory. CONCLUSIONS: More complications are related to neobladder than to ileac conduit. LRC with minilaparotomy seems to be an attractive treatment option for patients with muscle-invasive bladder cancer. Radical cystectomy performed intracorporeally could be reserved for 'robot-assisted' operations.