•In this single-centre study, SPARE score is as accurate as PADUA and RENAL score to predict surgical outcomes in RAPN.•SPARE score may be used to predict TRIFECTA achievement after RAPN.•Patients ...with higher SPARE score are at higher risk of eGFR decrease after RAPN.•The adoption of SPARE scoring system to assess tumor complexity should be recommended.
International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN).
Three hundred and sixty-eight consecutive RAPN patients were included. Primary endpoints were overall complications, postoperative acute kidney injury (AKI) and TRIFECTA achievement. Secondary endpoint was estimated glomerular filtration rate (eGFR) decrease at last follow-up. Multivariable logistic and linear regression models were used.
Of 368 patients, 229 (62%) vs. 116 (31%) vs. 23 (6.2%) harboured low- vs. intermediate- vs. high-risk renal mass, according to SPARE classification. SPARE score predicted higher risk of overall complications (Odds ratio OR: 1.23, 95%CI 1.09–1.39; P < 0.001), and postoperative AKI (OR: 1.20, 95%CI 1.08–1.35; P < 0.01). Moreover, SPARE score was associated with lower TRIFECTA achievement (OR: 0.89, 95%CI 0.81–0.98; P = 0.02). Predicted accuracy was 0.643, 0.614 and 0.613, respectively. After a median follow-up of 40 (IQR: 21–66) months, eGFR decrease ranged from -7% in low-risk to -17% in high-risk SPARE.
SPARE scoring system predicts surgical success in RAPN patients. Moreover, SPARE score is associated with eGFR decrease at long-term follow-up. Thus, the adoption of SPARE score to objectively assess tumor complexity prior to RAPN may be preferable.
•Validated tools to objectively assess radical cystectomy (RC) quality are lacking.•Patients achieving RC-Pentafecta showed higher 5-year OS and CSS.•RC-Pentafecta achievement was associated with ...surgical experience.•RC-Pentafecta is a valuable tool to assess surgical quality of RARC.•RC-Pentafecta can identify “referral” centers for treatment of high-risk bladder cancer.
Radical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at ≤12 months, absence of soft tissue surgical margins, ≥16 lymph nodes at final pathology and absence of clinical recurrence at ≤12 months) on oncological outcomes and the role of surgical experience on its achievement.
We retrospectively evaluated 366 patients undergoing RARC with intracorporeal urinary diversion in a single tertiary centre with a minimum of 1 year follow-up. Surgeries were performed using the DaVinci Xi system according to a previously described technique. Kaplan-Meier curves were used to investigate 5-years overall survival and cancer specific mortality-free survival (CSS) according to RC-Pentafecta achievement. Multivariable Cox's regressions were performed to evaluate the impact of RC-Pentafecta on overall mortality. Multivariable logistic regressions were performed to explore the effect of surgical experience on RC-pentafecta achievement. Locally weighted scatterplot smoother function was used to graphically explore this relationship.
Patients achieving RC-Pentafecta showed higher 5-year overall survival (71.8% vs. 59.6%, P < 0.001) and CSS (84% vs. 71%, P < 0.001) when compared with patients not achieving it. At multivariable Cox's regression, RC-Pentafecta achievement (HR 0.57, P = 0.03), positive surgical margins (HR 2.48, P = 0.002), pN+ (HR 2.23, P = 0.002), pT≥3 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P < 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT≥3 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed.
RC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify “referral” centers for treatment of high-risk bladder cancer.
Indwelling catheter removal on postoperative day 2 after robot-assisted radical prostatectomy (RARP) is a safe and feasible option, with acceptable rates of acute urinary retention and no impact on ...short- and long-term functional outcomes. Since a bladder catheter represents a burden on patient quality of life, our results suggest that very early removal after RARP can be encouraged for selected patients.
We evaluated the feasibility and impact on short- and long-term functional outcomes of very early catheter removal on postoperative day (POD) 2 after robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the first multisurgeon study with the largest cohort on very early (POD 2) catheter removal after RARP with follow-up of >1 yr. In 255/369 patients (69%) treated with RARP ± pelvic lymph node dissection, the catheter was removed on POD 2. Among the 255 patients, 33 (13%) required recatheterisation because of acute urinary retention after catheter removal. Of these 33 patients, five (2%) also experienced anastomotic leakage after catheter removal. The early (≤3 mo) urinary continence rate was 67% and the median time to urinary continence recovery was 1 mo. After median follow-up of 18 mo (interquartile range 13–24), 236 patients (88%) were continent. No anastomotic strictures occurred. Our observations confirm the feasibility and safety of POD 2 catheter removal after RARP and support its adoption for selected patients.
After removal of the prostate for cancer, patients have a urinary catheter inserted. We investigated whether earlier removal of the catheter affects long-term urinary continence. The results show that it may be safe to remove the catheter on postoperative day 2 for selected patients.
Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) for non-metastatic bladder cancer (BCa) are limited. The purpose of this study is to describe long-term ...oncologic outcomes of patients receiving robotic radical cystectomy at a high-volume European Institution. We analyzed data of 107 patients treated with RARC between 2003 and 2012 at a high-volume robotic center. Clinical, pathologic, and survival data at the latest follow-up were collected. Clinical recurrence (CR)-free survival, cancer-specific mortality (CSM)-free survival, and overall survival (OS) were plotted using Kaplan–Meier survival curves. Cox proportional hazard models investigated predictors of CR and CSM. Competing-risk regressions were utilized to depict cumulative incidences of death from BCa and death from other causes after RARC at long term. Pathologic nonorgan-confined BCa was found in 40% of patients, and 7 (7%) patients had positive soft tissue surgical margins. Median (interquartile range IQR) number of nodes removed was 11 (6, 14), and 26% of patients had pN + disease. Median (IQR) follow-up for survivors was 123 (117, 149) months. The 12-year CR-free, CSM-free and overall survival were 55% (95% confidence interval CI 44%, 65%), 62% (95% CI 50%, 72%), and 34% (95% CI 24%, 44%), respectively. Nodal involvement on final pathology was associated with poor prognosis on multivariable competing risk analysis. The cumulative incidence of non-cancer death exceeded that of death from BCa after approximately ten years after RARC. We provided relevant data on oncologic outcomes of RARC at a high-volume robotic center, with acceptable rates of clinical recurrence and cancer-specific survival at long-term. In patients treated with RARC, the cumulative incidence of death from causes other than BCa is non-negligible, and should be taken into consideration for post-operative follow-up.
Worldwide, we have witnessed an expansion of robot-assisted laparoscopic surgery (RALS) and thanks to the global adoption of high-resolution diagnostic imaging technologies, an increased incidence of ...newly diagnosed prostatic, renal and bladder cancers has been recorded with concurrent second primary urological cancer diagnoses increasing by 1.5%. Diverse authors have reported their findings concerning synchronous multi-visceral malignances robotic treatment within the scientific literature. The aim of this study is to comprehensively review all reported articles describing concurrent upper and lower RALS using a singular robotic port scheme within the same intervention for renal malignances and concomitant prostatic or bladder cancers. To the best of our knowledge and vigorous literature search, this is the first study that comprehensively evaluates and reports all combined upper and lower urinary tract surgeries published so far. In carefully selected patients, thanks to multidisciplinary preoperative assessment and surgical planning a combined robotic approach can reduce the morbidity, complications, hospital admissions and the overall length of hospitalization.
The present study elucidates the association between students’ education type and alcohol use, controlling for other socio-economic background characteristics. A subsample of data from the second ...International Self-Reported Delinquency Study was used (N= 10,525), collected among adolescents in the seventh to ninth grades of secondary school in four Western European countries (Belgium, the Netherlands, Germany and Austria). Data were analyzed with multilevel logistic regression techniques. There is an indication that type of education affects prevalence rates of drunkenness and heavy episodic drinking; these effects prove robust for differences in socio-economic backgrounds. The results of this study support the literature regarding the role of the educational system in the reproduction of health inequalities and underscore the finding that students from education types of lower status are at greater risk than those from higher status types.
In this contribution we study the propagation constant of interconnects subject to line edge roughness by means of an efficient stochastic framework. By employing the stochastic testing method, we ...succeed in limiting the number of calls to the full-wave electromagnetic field solver at the core of the system. Additionally, the computationally burdensome solution of the eigenvalue problem is eased by reducing its order through projection on an appropriate basis. The resulting two-step accel-eration leads to an effective approach to assess the effect of line edge roughness on the characteristics of interconnects. The novel framework is applied to a rough rectangular waveguide and a microstrip.
Objective We investigated the survival of patients who had undergone elective reconstruction of the ascending aorta for degenerative aneurysms. The long-term survival was compared to an age- and ...sex-matched case-control population. An analysis of risk factors, infl uencing survival was made.
Methods and results From May 1998 to-01-2012, 72 patients underwent elective reconstruction of the ascending aorta for degenerative disease at the department of Cardiothoracic Surgery of the Jessa Hospital, Hasselt, Belgium. Sixty patients were treated with Bentall procedures, whereas 12 received valve-sparing procedures. The average age of the patient group was 65.5 years (range 24-80), with 64% males. Thirty-day mortality was 9.7% (consistent with calculated Euroscore II: 9.2%). The long-term survival was 80.9% at 3, 5 and 10 years. No deaths occurred between 3 and 10 years postoperatively. In an age- and sex case-matched Belgian population, 3-, 5- and 10-year survival were 95.7%, 94.7% and 85.2%, respectively. Long-term survival was not signifi cantly diff erent between both groups. Poor NYHA class at the time of surgery (P = 0.041) and COPD (P = 0.028) had a signifi cant impact on global survival. Valve-sparing operations provide similar long-term survival, avoiding thrombo-embolic complications.
Conclusions Reconstruction of the ascending aorta for degenerative aneurysmal disease restores normal life expectancy, compared with an age- and sex-matched case-control population. Early mortality is consistent with the Euroscore II risk calculation. Whereas late survival progressively declines in the average population, it remains constant in the treated group after 3 years. COPD and poor functional class signifi cantly impair survival. Valve-sparing procedures confer a similar long-term survival as valve replacement.
The aim of this contribution is to study the effect of roughness on the propagation constant in interconnect structures. For this purpose, a stochastic framework is constructed around a full-wave ...electromagnetic field solver. To reduce the number of repeated calls to the full-wave simulator, two sparse stochastic techniques have been implemented and tested. A balance between calculation time and accuracy is sought for and found, which is demonstrated for a rough rectangular waveguide.
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