Timothy Kim

Predicting postoperative complications of inguinal lymph node dissection for penile cancer in an international multicentre cohort

To assess the potential complications associated with inguinal lymph node dissection (ILND) across international tertiary care referral centres, and to determine the prognostic factors that best predict the development of these complications.

Effect of utilization of veno-venous bypass vs. cardiopulmonary bypass on complications for high level inferior vena cava tumor thrombectomy and concomitant radical nephrectomy

ABSTRACT Purpose: To determine if patients with renal cell carcinoma (RCC) with levels III and IV tumor thrombi are receive any reduction in complication rate utilizing veno-venous bypass (VVB) over cardiopulmonary bypass (CPB) for high level (III/IV) inferior vena cava (IVC) tumor thrombectomy and concomitant radical nephrectomy. Materials and Methods: From May 1990 to August 2011, we reviewed 21 patients that had been treated for RCC with radical nephrectomy and concomitant IVC thrombectomy employing either CPB (n =16) or VVB (n=5). We retrospectively reviewed our study population for complication rates and perioperative characteristics. Results: Our results are reported using the validated Dindo-Clavien Classification system comparing the VVB and CPB cohorts. No significant difference was noted in minor complication rate (60.0% versus 68.7%, P=1.0), major complication rate (40.0% versus 31.3%, P=1.0), or overall complication rate (60.0% versus 62.5%, P=1.0) comparing VVB versus CPB. We also demonstrated a trend towards decreased time on bypass (P=0.09) in the VVB cohort. Conclusion: The use of VVB over CPB provides no decrease in minor, major, or overall complication rate. The use of VVB however, can be employed on an individualized basis with final decision on vascular bypass selection left to the discretion of the surgeon based on specifics of the individual case.

Imaging in Localized and Advanced Bladder Cancer

Bladder cancer is the most common neoplasm of the urinary tract and imaging has become vital in both the diagnosis and management of these patients. There are many different imaging modalities (e.g. ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography, bone scans), each with their specific applications. It is important to understand the merits of each modality to use them in the proper clinical setting. As the use of neoadjuvant chemotherapy becomes more prevalent, accurate clinical staging of patients with advanced disease is paramount. This chapter discusses the role of multiple imaging modalities in the setting of both non-muscle invasive and muscle invasive bladder cancer, as well as in the setting of neoadjuvant chemotherapy and surveillance.

Utilizing percentage of sarcomatoid differentiation as a prognostic factor in renal cell carcinoma.

507 Background: Sarcomatoid renal cell carcinoma (sRCC) is a histologic feature that denotes an aggressive variant of kidney cancer and worse overall outcomes. Our aim was to determine if the percentage of sarcomatoid differentiation (% Sarc) could be used for prognostic risk stratification. Methods: We performed a retrospective analysis of patients who underwent surgery at our center and found to have sRCC. A single genitourinary pathologist reviewed each specimen for %Sarc and other pathologic variables of interest. %Sarc was analyzed as a continuous variable and as a binary variable using cut-points of 5%, 10%, and 25%. Potential prognostic factors associated with overall survival (OS) were determined using the Cox regression model. OS curves were generated with Kaplan-Meier methods and survival differences compared using the log-rank test. Results: Between 1998 and 2012, 1,307 consecutive cases of RCC were identified, of which 59 patients were confirmed to have sRCC (4.5%). As a continuous variable %S...

Correlation of abnormal upper tract cytology and tumor histology in patients who have undergone a nephroureterectomy for urothelial carcinoma with disease recurrence in the bladder.

288 Background: 15-50% of patients with upper tract urothelial carcinomas (UTUC) will have a bladder recurrence. Abnormal upper tract cytology (UTC) is an indicator of higher grade tumors but has not been associated with bladder recurrence. We were interested in investigating the role of UTC as a predictor of bladder cancer recurrences in patients with no prior history of bladder cancer presenting with UTUC. METHODS Of 67 patients who had an UTC collected prior to their nephroureterectomy (NU) in 2004-2012, we identified 17 patients with a recurrent disease in the bladder who met the criteria of having no previous history of bladder cancer at the time of their NU. UTC and histology were reviewed and analyzed with the bladder pathology data. Positive or suspicious cytology was defined as abnormal and atypical or reactive as benign. RESULTS 15 (88%) of 17 patients (11 men and 6 women) who met our criteria were diagnosed with bladder cancer within one year after their NU (average 7.5 months (range 2-26)). 10 (59%) of 17 patients had abnormal UTC with a calculated sensitivity and specificity of 59% and 22%, respectively. 7 (70%) of 10 patients with abnormal UTC compared to 5 (71%) of 7 patients with benign cytology had high grade (HG) bladder cancer (p=1.0). Muscle invasive tumors were found in 5 (29%) of 17 patients and 3 (60%) of those had abnormal UTC. All six women had HG bladder cancer compared to 6 of 10 men (p=0.23). HG tumors were slightly more common in the bladder compared to the upper tract (75% vs 65%, p=0.70) and 14 (87.5%) of 16 bladder tumors had the same tumor grade in the upper tract. CONCLUSIONS Abnormal UTC is a poor predictor of bladder recurrence in patients with a history of UTUC. The majority of patients who developed bladder recurrence presented within one year from NU with HG disease which underscores the importance of aggressive surveillance and the consideration of prophylactic intravesical therapy at the time of NU in this patient cohort.