Biomedical subjects

Antonio Finelli

Publications and source records attributed to Antonio Finelli.

28 records · Page 2Linked to original sources

PubMed2004

Laparoscopic versus open cytoreductive nephrectomy for metastatic renal cell carcinoma.

OBJECTIVES: To compare the outcomes of those patients who underwent laparoscopic versus open cytoreductive nephrectomy. Cytoreductive nephrectomy before systemic therapy has been shown to offer a survival advantage compared with systemic therapy alone for metastatic renal cell carcinoma. METHODS: We reviewed the outcomes of all patients who underwent either open or laparoscopic cytoreductive nephrectomy between 2000 and 2003. The inclusion criteria included patients with tumors 15 cm or less without local invasion, venous involvement, or bulky local adenopathy who had concurrent metastatic disease. A total of 64 patients (22 in the laparoscopic group and 42 in the open group) fulfilled these criteria. The parameters measured were age, tumor size, operative time, estimated blood loss, complications, length of hospital stay, percentage of patients receiving systemic therapy, and the interval to the start of systemic therapy. Kaplan-Meier survival estimates were compared. RESULTS: Patients who underwent laparoscopic cytoreductive nephrectomy had a shorter length of stay (2.3 versus 6.1 days) and less operative blood loss (288 versus 1228 mL) than those who underwent open nephrectomy. Patients in the laparoscopic group received systemic therapy sooner after surgery (36 versus 61 days) than those in the open group. The Kaplan-Meier survival estimates were similar for both groups, with a 1-year survival rate of 61% in the laparoscopic group and 65% in the open group. CONCLUSIONS: With judicious patient selection, laparoscopic cytoreductive nephrectomy can be performed safely, with minimal morbidity, and may shorten the interval from nephrectomy to the start of systemic therapy.

Blood Loss, Surgical↗

PubMed2004

Laparoscopic radical nephrectomy for large (greater than 7 cm, T2) renal tumors.

PURPOSE: Laparoscopic radical nephrectomy has emerged as a standard of care in appropriate candidates with clinical stage T1 renal tumors (7 cm or less). Herein we present our experience with laparoscopic radical nephrectomy for clinical stage T2 tumors (greater than 7 cm). MATERIALS AND METHODS: Patients undergoing laparoscopic radical nephrectomy between September 1997 and July 2003 were retrospectively subdivided into group LAPT1-166 with tumor size 7 cm and group LAPT2-65 with tumor size greater than 7 cm. Also, group LAPT2 was compared with a group of 34 contemporary, comparable patients undergoing open radical nephrectomy for tumor greater than 7 cm (group OPENT2). RESULTS: Compared with group LAPT1, group LAPT2 had younger patients, larger tumors and greater blood loss (100 vs 200 ml) (each p <0.001). Importantly operative time, analgesic requirements, hospital stay, and convalescence and complication rates were comparable. Group LAPT2 and group OPENT2 patients had similar sized tumors (9.2 and 9.9 cm, respectively) but shorter operative time (p = 0.03), lesser blood loss (p <0.001), shorter hospital stay (p <0.001) and more rapid convalescence (p = 0.02) occurred in LAPT2. CONCLUSIONS: Laparoscopic radical nephrectomy for stage T2 renal masses (greater than 7 cm) is feasible and efficacious. Laparoscopic nephrectomy offers the advantages of decreased blood loss, shorter hospital stay and more rapid recovery over open radical nephrectomy for comparable tumors greater than 7 cm. Although surgical outcomes are comparable with laparoscopic radical nephrectomy for smaller tumors (7 cm or less), adequate laparoscopic experience is necessary before performing radical nephrectomy for large T2 tumors.

Aged↗

PubMed2004

Laparoscopic extended pelvic lymphadenectomy for bladder cancer: technique and initial outcomes.

PURPOSE: We describe the technique and our evolving outcomes of laparoscopic extended pelvic lymphadenectomy for bladder cancer. MATERIALS AND METHODS: Since 1999 laparoscopic radical cystectomy with pelvic lymphadenectomy and intracorporeal urinary diversion has been performed in 22 patients. The initial 11 patients underwent limited dissection (group 1) and the subsequent 11 consecutive patients underwent extended lymphadenectomy (group 2). Our split-and-roll technique of laparoscopic extended pelvic lymphadenectomy has evolved to achieve lymphatic tissue clearance by bilaterally skeletonizing the genitofemoral nerve, external iliac artery, external iliac vein, obturator nerve, hypogastric artery, common iliac artery and pubic bone. RESULTS: Extended lymphadenectomy added 1.5 hours of operative time. The median number of nodes retrieved was 3 and 21 in groups 1 and 2, respectively (p = 0.001). Three patients per group were found to have positive nodal disease. In 1 patient undergoing extended dissection injury to a deep pelvic vein was managed by intracorporeal suturing and resulted in 200 ml blood loss. Two other patients had deep venous thrombosis. At a mean followup of 11 months (range 2 to 43) there were no port site recurrences. CONCLUSIONS: Laparoscopic extended pelvic lymphadenectomy for bladder cancer can be performed with anatomical boundaries and nodal yields commensurate with those of current recommendations for open surgery.

Adenocarcinoma↗

PubMed2004

Laparoscopic cytoreductive nephrectomy for metastatic renal cell carcinoma.

OBJECTIVE: To critically analyse the results of laparoscopic cytoreductive surgery for renal cell carcinoma (RCC), as phase III evidence supports cytoreductive nephrectomy before immunotherapy, and there is an overall shift towards minimally invasive renal surgery for this disease. PATIENTS AND METHODS: Since October 2000, 22 patients were treated by laparoscopic cytoreductive nephrectomy for metastatic RCC (group 1). All patients had radiological evidence of metastatic disease, with biopsy confirmation in 10. To put the results into perspective, 25 consecutive contemporary patients with large organ-confined nonmetastatic RCC (>7 cm, clinical stage T2) undergoing laparoscopic radical nephrectomy (group 2) were compared retrospectively. The baseline demographics were comparable between the groups. RESULTS: The mean tumour size was 8 cm in group 1 and 9.6 cm in group 2 (P = 0.07). Variables during and after surgery were comparable between the groups, with a mean operative duration of 3.1 vs 3.2 h (P = 0.82), blood loss of 285 vs 308 mL (P = 0.79), complications in two vs eight (P = 0.08), morphine sulphate equivalent requirements of 51.7 vs 44.1 mg (P = 0.1) and a median length of hospital stay of 1.7 vs 1.6 days (P = 0.68). In group 1 the median (range) time to immunotherapy was 35 (13-136) days. CONCLUSIONS: Laparoscopic cytoreductive nephrectomy is safe and effective in selected patients. Currently the procedure is offered to candidates eligible for immunotherapy and with tumours of < or = 15 cm, and no evidence of adjacent organ invasion or inferior vena caval thrombus. Significant perihilar adenopathy and numerous parasitic vessels can increase the complexity of the surgery. Adequate laparoscopic experience is necessary.

Carcinoma, Renal Cell↗

PubMed2003

Cryotherapy and radiofrequency ablation: pathophysiologic basis and laboratory studies.

PURPOSE OF REVIEW: There is increasing interest in minimally invasive alternatives to surgery, especially as the natural history of small renal masses appears in the majority to be that of very slow growth. Cryoablation and radiofrequency ablation are two energy-based therapies that can be applied in a minimally invasive manner. We will review the recent clinical and laboratory studies that have formed the scientific foundation of the current clinical protocols and how these protocols may change in light of recent observations. RECENT FINDINGS: Although there is literature supporting enhanced cell death with the use of a passive thaw in cryoablation, recent data suggest that the use of an active thaw is no different. The active thaw process will effectively cryoablate renal tissue as well as significantly reduce overall operative time. There is lack of uniformity in the effectiveness of radiofrequency ablation for renal masses. It has been concluded that hematoxylin and eosin staining is inadequate for assessment of cell viability after radiofrequency ablation and thus, nicotinamide adenine dinucleotide staining should be included in the histological assessment of tissue. SUMMARY: Cryoablation is the most studied modality and its ability to both directly and indirectly damage cells is generally understood. Clinical experience will further refine knowledge about optimal freezing temperature and freeze-thaw cycles. The coagulation necrosis of radiofrequency ablation is an effective means of destroying cancerous tissue but targeting this energy has been difficult and treatment failures have occurred.

Catheter Ablation↗

PubMed2003

Use of in-biofilm expression technology to identify genes involved in Pseudomonas aeruginosa biofilm development.

Mature Pseudomonas aeruginosa biofilms form complex three-dimensional architecture and are tolerant of antibiotics and other antimicrobial compounds. In this work, an in vivo expression technology system, originally designed to study virulence-associated genes in complex mammalian environments, was used to identify genes up-regulated in P. aeruginosa grown to a mature (5-day) biofilm. Five unique cloned promoters unable to promote in vitro growth in the absence of purines after recovery from the biofilm environment were identified. The open reading frames downstream of the cloned promoter regions were identified, and knockout mutants were generated. Insertional mutation of PA5065, a homologue of Escherichia coli ubiB, was lethal, while inactivation of PA0240 (a porin homologue), PA3710 (a putative alcohol dehydrogenase), and PA3782 (a homologue of the Streptomyces griseus developmental regulator adpA) had no effect on planktonic growth but caused defects in biofilm formation in static and flowing systems. In competition experiments, mutants demonstrated reduced fitness compared with the parent strain, comprising less than 0.0001% of total biofilm cells after 5 days. Therefore, using in-biofilm expression technology, we have identified novel genes that do not affect planktonic growth but are important for biofilm formation, development, and fitness.

Alcohol Dehydrogenase↗

PubMedDate not supplied

Laparoscopic partial nephrectomy: contemporary technique and results.

An increasing number of incidental small renal masses are being detected currently. In select patients, nephron-sparing surgery affords excellent oncologic outcomes with preservation of renal function. With the current trend towards minimally invasive surgery, development of a reliable laparoscopic partial nephrectomy technique has become a key issue. Over the past 4 years, the senior author has performed over 300 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique and review contemporary results from the urologic literature.

Clinical Trials as Topic↗

PubMedDate not supplied

Critique of laparoscopic lymphadenectomy in genitourinary oncology.

Regional lymphadenectomy is prognostic and selectively therapeutic in urologic oncology. The role of lymphadenectomy continues to be defined with the evolving multimodal management of genitourinary malignancies. Laparoscopy is playing a greater role in the management of genitourinary malignancies and thus, it is germane to critique the role of laparoscopic lymphadenectomy in the management of these tumors. Review of the literature suggests that laparoscopic pelvic lymphadenectomy is feasible with nodal yields commensurate to those in open published series. Although laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumor is feasible, the technique and efficacy of this procedure require further investigation.

Humans↗

PubMedDate not supplied

Laparoscopic rectovesical fistula repair.

BACKGROUND AND PURPOSE: Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 62- year-old man with clinically localized prostate cancer underwent open radical prostatectomy that was complicated by rectal injury and subsequent RVF development. Conservative management failed, and the patient was referred for surgical correction. TECHNIQUE: The operative steps consisted of (1) cystoscopy, (2) RVF catheterization, (3) ureteral catheterization, (4) five-port transperitoneal laparoscopic approach, (5) cystotomy, (6) opening of the fistulous tract, (7) dissection between the bladder and the rectum, (8) closure of the rectum, (9) interposition of omentum, (10) suprapubic cystostomy placement, (11) bladder closure, and (12) colostomy creation. RESULTS: The operative time was 240 minutes. The hospital stay was 3 days. The urethral catheter was kept indwelling for 4 days. At 8 weeks postoperatively, the suprapubic tube was removed and the colostomy reversed. At 1-month follow-up, the patient remains free of fistula recurrence. CONCLUSION: Laparoscopic rectovesical fistula repair is feasible and represents an attractive alternative to the standard approaches.

Cystoscopy↗

PubMedDate not supplied

Laparoscopic partial nephrectomy for cancer: techniques and outcomes.

Open partial nephrectomy is the gold standard nephron-sparing treatment for small renal tumors. Technical aspects of laparoscopic partial nephrectomy have evolved considerably, and the technique is approaching established status at our institution. Over the past 4 years, the senior author has performed more than 400 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique and review contemporary outcome data.

Cohort Studies↗