Mazen Abdelhady

Clinically significant prostate cancer found incidentally in radical cystoprostatectomy specimens

To review the incidence, histopathological features and clinical outcomes of patients with incidental prostate cancer found in radical cystoprostatectomy (RCP) specimens excised for bladder cancer, to determine if these cancers affected the follow‐up strategy and if prostate‐sparing cystectomy would be appropriate for these patients.

Review of Primary and Salvage Cryoablation for Prostate Cancer

BACKGROUND Cryosurgery has gained popularity as a minimally invasive treatment option for primary and recurrent prostate cancer. Herein we present a review and summary reports on primary cryoablation for prostate cancer and salvage cryoablation following radiation failure. METHODS We reviewed the current published literature in the English language on these topics, along with some historic articles dating back to the 1960s for background and development of the procedure. The material is supplemented by some commentary based on our own 13-year experience with cryoablation for prostate cancer. The review is divided into two sections: primary and salvage cryoablation. RESULTS For primary cryoablation, success rates are proportional to the risk categories of the primary cancers. A pretreatment prostate-specific antigen (PSA) <or= 10 ng/mL and an undetectable PSA nadir following cryoablation are associated with a more favorable long-term outcome. Safety profile and quality of life are acceptable in carefully selected patients. Similarly, for salvage cryoablation following radiation failure, patient selection is of paramount importance. The most consistently identified predictive factors for poor cryoablation outcomes were pre-cryoablation PSA > 10 ng/mL and post-cryoablation nadir PSA > 1 ng/mL for salvage procedures. Side effects are more prevalent and serious than with primary cryoablation but for carefully selected patients, the long-term results are favorable. CONCLUSIONS Patient selection is the key to success with cryoablation, in both the primary and salvage setting. The modality can offer long-term cancer control in carefully selected patient with properly executed techniques.

Ureteral frozen sections at the time of radical cystectomy: reliability and clinical implications

BACKGROUND We hypothesized that the incidence of ureteral abnormalities on frozen section analysis (FS) at the time of radical cystectomy is much lower than historical values and that FS has minimal impact on outcomes. We also sought to determine the accuracy of FS and the associated costs. METHODS We reviewed the records of 301 patients who underwent a radical cystectomy for urothelial carcinoma of the bladder (UC) between March 2000 and January 2007. The ureteral margins were sent for FS and subsequent permanent hematoxyllin and eosin (H&E) sections and results were compared. Analyses were performed to determine the costs of FS and if any association was present with the pathological stage of the primary bladder tumour and regional lymph nodes, the presence of urothelial carcinoma in situ of the bladder (CIS) and survival outcomes with the FS. RESULTS We identified 602 ureters for this study. The incidence of CIS or solid urothelial carcinoma in the ureter was 2.8%. The presence of CIS of the bladder and prostatic urethra was significantly associated with a positive FS (p = 0.02). The FS were not associated with survival outcomes. The cost to pick up 1 patient with any abnormality on FS was

Quality Assurance and Benchmarking for Radical Cystectomy: Monitoring Early Complications and Mortality Using Cumulative Summation Charts

2080. The cost to pick up 1 patient with CIS or solid urothelial carcinoma of the ureter on FS was

Surgical cryoablation as an option for small renal masses in patients who are not ideal partial nephrectomy candidates: intermediate-term outcomes.

6471. CONCLUSION The incidence of CIS and tumour on FS during radical cystectomy for UC is low. The costs associated with FS are substantial. Frozen section analysis should only be performed in select patients undergoing radical cystectomy.

1128: Salvage Cryoablation Outcomes - Analysis of Predictive Factors in a Large Cohort of Patients

PURPOSE Cumulative summation is one method for quality assurance that has recently been adapted to the medical field to monitor any binary surgical outcomes on an ongoing basis. In this study we used cumulative summation charts for quality assurance in radical cystectomies. MATERIALS AND METHODS Cumulative summation charts were generated from prospectively collected data for the first 150 radical cystectomies performed by a single surgeon from 2001 to 2007. Overall and disease specific survival were estimated using the Kaplan-Meier actuarial methodology and stratified by pathological stage. Based on a literature review acceptable rates were identified as death 0.3% to 4%, ureterointestinal leak 0.3% to 1%, unplanned reoperation 2.3% to 17%, myocardial infarction 0.3% to 2% and pulmonary embolism 0.4% to 2%. RESULTS Median followup was 16 months. There were 12, 12, 41, 26, 25 and 34 patients with pTis, pT1, pT2, pT3, pT4 and pN+ disease, respectively. The 5-year disease specific survival for less than pT2, pT2, pT3, pT4 and pN+ was 92%, 90%, 60%, 51% and 30%, respectively. The occurrence of postoperative death, rectal injury, ureterointestinal anastomotic leak, immediate reoperation, myocardial infarction and pulmonary embolus for the 150 patients was 1, 0, 3, 2, 2 and 3, respectively. Cumulative summation graphs allowed a visual guide to the key performance indicators. CONCLUSIONS Using cumulative summation surgeons can continuously identify if their morbidity or mortality rates are approaching benchmark limits. This approach may provide more timely information when alterations in surgical technique, patient selection and perioperative care should be considered if benchmark limits are being approached for a variety of surgical outcomes.