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Surena F Matin

Publications and source records attributed to Surena F Matin.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic cytoreductive nephrectomy: the M. D. Anderson Cancer Center experience.

OBJECTIVES: Cytoreductive nephrectomy (CN) is an integral component in treating patients with metastatic renal cell carcinoma. Critics of CN argue that perioperative morbidity or postoperative disease progression may preclude patients from receiving systemic therapy. Laparoscopic cytoreductive nephrectomy (LCN) may allow for reduced morbidity and may increase the likelihood of patients receiving systemic therapy. METHODS: From April 2001 to March 2005, 38 patients underwent LCN at our institution. We evaluated perioperative parameters such as demographics, blood loss, operative time, complications, follow-up time, interval to systemic therapy, and survival. A contemporary open cytoreductive surgery group was evaluated for comparison. RESULTS: The median patient age was 62 years (range 41 to 82). Most patients had a performance status of 1 or less. The median operative time was 188 minutes, and the median blood loss was 175 mL. All specimens were removed intact. The median tumor size was 8 cm (range 3.5 to 14). The median hospitalization was 3 days. Two major (5.7%) and four minor (11.4%) complications occurred, but no perioperative mortality. Postoperatively, 97.4% of patients were eligible for, or received, systemic therapy at a median of 41 days. The overall median survival was 18.1 months. In contrast to open CN, LCN resulted in decreased blood loss and hospital stay, with no differences in complications, operative time, or interval to systemic therapy. CONCLUSIONS: LCN is a safe and effective surgical approach for select patients with metastatic renal cell carcinoma. Our results have indicated that with proper patient selection, LCN is feasible, morbidity is minimized, and systemic therapy is delivered in a timely fashion.

Adult↗
PubMed2006

Recognition and preservation of accessory pudendal arteries during laparoscopic radical prostatectomy.

OBJECTIVES: To determine the incidence of, and ability to preserve, accessory pudendal arteries (APAs) in patients undergoing laparoscopic radical prostatectomy (LRP). The incidence of APAs is not well established. Preservation of APAs may be important for the maintenance of erectile function after prostatectomy. Data are limited regarding the ability to preserve APAs during laparoscopic surgery. METHODS: At the beginning of each of 70 consecutive laparoscopic radical prostatectomies performed at my institution, a purposeful search for APAs was performed during dissection of the space of Retzius. The operative findings were systematically dictated, and video documentation was obtained whenever possible. In every case in which APAs were identified, an attempt was made to spare them. RESULTS: Of the 70 patients, 18 (25.7%) were identified as having 23 APAs on the left (n = 8), right (n = 5), or both (n = 5) sides. Documentation and the technique of preservation are detailed in the accompanying video. In all but 1 case, APAs were identified at the initial exploration. APAs were preserved in 78.3% of cases. Of 10 preoperatively potent, sexually active men undergoing bilateral nerve-sparing surgery, all had preservation of APAs. CONCLUSIONS: The incidence of APAs in this consecutive series of LRP was 25.7%. Preservation of the APAs was successful in 78.3% of those with APAs found. Although occasionally the anatomy may not permit vascular preservation, vigilant examination and strategic laparoscopic dissection allow APAs to be successfully spared in most cases.

Adult↗
PubMed2006

Residual and recurrent disease following renal energy ablative therapy: a multi-institutional study.

PURPOSE: In this study we detail the incidence and pattern of residual and recurrent disease after radio frequency ablation or cryoablation of a renal mass and, using this information, determine reasonable minimum recommendations for when to perform surveillance imaging during year 1 after treatment. To our knowledge no evidence based guidelines exist for determining how or when followup abdominal imaging should be performed after renal energy ablative therapy. MATERIALS AND METHODS: We reviewed treatment and followup information of patients who underwent radio frequency ablation or cryoablation for a renal mass at 7 institutions. Postoperative monitoring was performed using a variety of surveillance schedules. RESULTS: Of 616 patients 63 were found to have residual or recurrent disease after primary radio frequency ablation (13.4%) or cryoablation (3.9%) for a median of 8.7% in 7 institutions. Most incomplete treatments (70%) were detected within the first 3 months. After salvage ablative therapy was rendered, therapy failed in only 4.2%. At a mean followup of 2 years patients with residual or recurrent disease had an overall survival rate of 82.5% and a 2-year metastasis-free survival rate of 97.4% for those with localized, unilateral renal tumors. CONCLUSIONS: In most cases initial treatment failure was detected within the first 3 months after treatment. Our findings support a minimum of 3 to 4 imaging studies in year 1 after ablative therapy, and at months 1, 3, 6 (optional) and 12.

Catheter Ablation↗
PubMed2006

Upper urinary tract tumors with nontransitional histology: a single-center experience.

OBJECTIVES: To review our experience with patients with upper urinary tract tumors of nonurothelial origin. Upper urinary tract tumors of nonurothelial origin are uncommon entities. To our knowledge, no series of patients with these neoplasms has been published in the past decade. METHODS: We reviewed the records at the University of Texas M. D. Anderson Cancer Center from 1990 to 2004 to identify patients with primary nonurothelial tumors of the upper urinary tract. We reviewed the patient records to collect data on tumor subtype, treatment, recurrence, and survival. RESULTS: Sixteen patients (1.9% of our database of patients with upper urinary tract tumors) were identified; 12 had squamous cell carcinoma, 2 had adenocarcinoma, 1 had sarcomatoid carcinoma, and 1 had small cell carcinoma. The tumors were located in the renal pelvis in 10 and the ureter in 6. Of the 16 patients, 15 had been treated with nephrectomy or nephrouterectomy and 1 with chemotherapy and radiotherapy. Fifteen of the tumors were pathologic Stage T3 or worse. Ten patients received adjuvant chemotherapy. Of the 16 patients, 9 died (1 of unknown causes), 4 were alive without disease, 2 were alive with disease, and 1 was alive at last follow-up with the disease status unknown. The median follow-up was 30.1 months, the median overall survival time was 11.3 months, and 1-year survival rate was 46%. The median recurrence-free survival time and 1-year recurrence-free survival rate were 5.8 months and 38%, respectively. CONCLUSIONS: Primary nonurothelial carcinomas of the renal pelvis and ureter are rare. Our analysis suggests a poor prognosis for most patients with these pathologic types, probably resulting from the advanced stage at diagnosis and poor responses to systemic therapy.

Carcinoma↗
PubMed2006

Partial nephrectomy for renal urothelial tumors: clinical update.

OBJECTIVES: To evaluate the contemporary indications and outcome after partial nephrectomy for renal urothelial cancer. Partial nephrectomy is an established treatment for renal cell cancer but its use for renal urothelial tumors has been studied less extensively. METHODS: Records were reviewed for patients undergoing partial nephrectomy for renal urothelial tumors between January 1990 and December 2001. Partial nephrectomy was selected for those with a solitary kidney, chronic renal insufficiency, or bilateral synchronous tumors. Partial nephrectomy was performed according to the principles of partial nephrectomy. Follow-up included ultrasonography, intravenous urography, computed tomography, metastatic workup, and renal function evaluation. RESULTS: This study included 12 patients (12 kidneys, 10 solitary) with a mean age of 68.5 +/- 21 years and a mean follow-up of 40.8 +/- 32 months. The pathologic T stage was Tis in 1 patient, T1 in 3, T2 in 2, and T3 in 6 patients. Of the 12 patients, 6 had negative surgical margins, and 4 of the 12 patients (30%) were tumor free after a mean follow-up of 57.7 months. Of the 6 patients with positive surgical margins (Stage T1 in 2 and T3 in 4), 1 developed recurrence and 3 developed metastasis; 4 died after a mean of 31.3 months. Overall recurrence was seen in 5 (42%) and progression (metastasis) in 6 (50%) patients. Of the 12 patients, 6 were alive, 4 of them were well (mean serum creatinine 1.83 mg/dL) at 62 months of follow-up. Two patients required dialysis. The overall long-term survival rate was 50%. CONCLUSIONS: Partial nephrectomy for renal urothelial tumors is feasible and should be considered in a select population. Dialysis or renal replacement can be delayed or avoided in most of these patients, but strict surveillance remains mandatory.

Aged↗
PubMed2006

Conventional and hand-assisted laparoscopic radical nephrectomy: Comparative analysis of 271 cases.

PURPOSE: To compare the outcomes of patients undergoing conventional laparoscopic radical nephrectomy (CLRN) and hand-assisted laparoscopic radical nephrectomy (HALRN) at our institution. PATIENTS AND METHODS: We prospectively and retrospectively reviewed the files of consecutive patients who underwent HALRN (N = 158 patients) from April 2001 to May 2005 and CLRN (N = 113) from August 2002 to May 2005 for clinical stage T(1-3)N(0-1)M(0-1) renal-cell carcinoma. Clinical and perioperative variables of the two groups were compared. Patients were well matched with regard to baseline parameters except that patients undergoing CLRN were 8 years older (P < 0.001) and had higher American Society of Anesthesiologists scores (P = 0.001). RESULTS: Significantly different outcomes were faster operative time (P < 0.001), greater use of narcotic analgesia (P < 0.001), and longer hospitalization (P < 0.001) with HALRN. For the other variables analyzed, including blood loss, incision size, and complication rates, the two approaches were not significantly different. CONCLUSIONS: Within the limitations of a retrospective study, HALRN was a faster operation than CLRN but was associated with greater use of narcotic analgesia and longer hospitalization. Overall, the similarities between these two approaches outnumber the differences, some of which may be explained by surgeon-specific practices. Both modalities offer patients excellent immediate cancer control while minimizing perioperative morbidity.

Adult↗
PubMed2006

Laparoscopic radical cystoprostatectomy with bilateral nephroureterectomy: initial report.

OBJECTIVES: To present our experience with laparoscopic radical cystoprostatectomy and bilateral nephroureterectomy for organ-confined, muscle-invasive transitional cell carcinoma (TCC) of the bladder in two patients with dialysis-dependent end-stage renal disease (ESRD). PATIENTS AND METHODS: Two men aged 77 and 65 years with organ-confined, muscle-invasive TCC of the urinary bladder and pre-existing dialysis-dependent ESRD underwent laparoscopic bilateral pelvic lymphadenectomy, radical cystoprostatectomy and bilateral nephroureterectomy. Urine spillage was avoided and en bloc urothelial integrity between the bladder and the two renal specimens was maintained throughout the procedure. The intact, entrapped specimens were removed en bloc via a Pfannenstiel incision at the end of the procedure. RESULTS: The total operative duration was 573 and 660 min, respectively, including repositioning and re-draping between each major step. Blood loss was 350 and 1000 mL, respectively. Both patients tolerated the procedure well and there were no intraoperative complications. The first patient resumed oral intake 3 days after surgery and was discharged home after 5 days. The second patient's course after surgery was complicated by a prolonged adynamic ileus and infection of the catheter placed for continuous ambulatory peritoneal dialysis. He was discharged 28 days after surgery and died from unknown causes at 30 days. CONCLUSIONS: To our knowledge, this is the first report of radical urotheliectomy, consisting of bilateral pelvic lymph node dissection, radical cystoprostatectomy, and bilateral nephroureterectomy, using entirely intracorporeal laparoscopic techniques.

Aged↗
PubMed2006

Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: Time to change the treatment paradigm?

OBJECTIVE: To evaluate factors associated with disease recurrence and survival in patients undergoing nephroureterectomy for upper urinary tract transitional cell carcinoma (UUT-TCC) in one centre over an 18-year period. PATIENTS AND METHODS: The records of patients who had a nephroureterectomy for UUT-TCC at our institution from 1986 to 2004 were reviewed for clinical, pathological and treatment period data. Cox's proportional hazards regression model was used to test the statistical significance of several potential prognostic factors for recurrence and survival. RESULTS The median overall duration of follow-up was 2.5 years for 184 patients. Significant prognosticators for disease-specific survival (DSS) by univariate analysis were tumour stage (P < 0.01), tumour grade (P < 0.01), node-positive disease (P < 0.01), multifocality (P = 0.03), previous cystectomy (P < 0.01) and synchronous bilateral UUT-TCC (P = 0.02). On multivariate analysis, only tumour stage (P = 0.03) and grade (P = 0.01) correlated with DSS. The median recurrence-free survival duration was 2.4 years. In 44 patients, the disease recurred outside the bladder; 15 (8.2%) had local recurrence, 20 (10.9%) distant metastasis, and nine (4.9%) both local and distant recurrence. Bladder tumours occurred in 40 (26.1%) patients with no previous cystectomy. The evaluation of treatment outcome during three periods of the study showed no significant effect on DSS. CONCLUSION: Tumour stage and grade correlated with DSS in this cohort, with no improvement in outcome over the 18-year period assessed. Patients with high-stage and high-grade disease continue to fare poorly, suggesting a need for changing the treatment protocol. Judiciously applying a multimodal approach to the management of high-risk patients by incorporating neoadjuvant chemotherapy and surgical resection might provide, for the first time, the opportunity to improve patient outcome.

Aged↗
PubMed2006

Percutaneous radiofrequency ablation: minimally invasive therapy for renal tumors.

Currently, up to 60% of renal tumors are detected incidentally by abdominal imaging. Most of these tumors are small and localized to the kidney. Owing to the shift to lower stage at diagnosis, radical nephrectomy has fallen out of favor and has been replaced by nephron-sparing surgery. Currently, partial nephrectomy is the treatment of choice for patients with small renal tumors. As the trend towards less invasive therapy continues, laparoscopic and percutaneous ablation techniques have gained popularity for the treatment of renal tumors in patients who are high-risk surgical candidates, or have a solitary kidney, limited renal function or multifocal disease. Percutaneous radiofrequency ablation is a safe, minimally invasive treatment option for those patients.

Adult↗
PubMed2005

Port-site metastasis: the influence of biology.

OBJECTIVE: Several surgical and technical mechanisms have been proposed for the development of port-site metastasis, but the influence of tumor and host biologic factors has not been emphasized. We present a case of a pelvic chordoma that metastasized to a prior laparoscopic radical nephrectomy port-site. METHODS: A 62-year-old woman underwent laparoscopic radical nephrectomy (LRN) for a pT1b grade 3 renal cell carcinoma, followed 6 weeks later by resection of a sacral chordoma. The incisions and areas of dissection for the two procedures were discontinuous. RESULTS: Eight months following the LRN she developed a nodule in one of the laparoscopic port-sites. The port-site metastasis was treated with wide surgical resection, which was confirmed as metastatic chordoma on histologic examination. CONCLUSION: Based on the chronological sequence and physical distance between surgical sites, only biological factors could have contributed to this port-site metastasis. This unusual case highlights the important role that tumor and host biologic mechanisms play in the development of port-site metastasis.

Carcinoma, Renal Cell↗
PubMed2005

Bilateral metastatic renal synovial sarcoma.

Synovial sarcoma is a malignant soft-tissue neoplasm, usually arising in close association with the joints and generally carrying a poor prognosis. We describe the first report of bilateral renal metastases from synovial sarcoma in a long-term survivor. Treatment consisted of systemic therapy with bilateral partial nephrectomies. The patient was disease free at 1 year of follow-up.

Amputation, Surgical↗
PubMed2005

Laparoscopic urology training in South Africa.

BACKGROUND AND PURPOSE: Laparoscopic urologic surgery is not widely practiced in South Africa. After presenting a laparoscopic training course, we evaluated how effectively this training translated into clinical practice. SUBJECTS AND METHODS: Invitations to the course were sent to all South African urologists. Ten applicants attended the course, which consisted of dry and in-vivo animal surgery. Two questionnaires were sent out after the course. Questionnaire 1 (at course completion) aimed at identifying the precourse laparoscopic experience and expectations of the trainee. Questionnaire 2 (6 months postcourse) assessed how much laparoscopic surgery the participant had performed since the course. RESULTS: Seventeen percent of all South African urologists responded to the invitation. Prior to the course, 40% of trainees had performed >or=10 laparoscopic cases, 30% had performed <10 cases, and 30% had never performed laparoscopy, whereas 60% expected to be doing one or two cases a month after completing the course. Six months after the course, 60% had performed no laparoscopic cases. Of the three trainees who had never before done laparoscopic procedures, none had started to perform procedures since the course. The commonest procedures performed were varicocelectomy and diagnostic laparoscopy for nonpalpable testis. CONCLUSIONS: A hands-on laparoscopic training course to introduce laparoscopic urology into South African private urology practice has not translated into a satisfactory number of clinical cases being performed. The causes are likely multifactorial but are greatly influenced by social and economic forces. One possible solution may be to offer a mentor-based training program.

Clinical Competence↗
PubMed2005

Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy.

PURPOSE: We report on a prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy for renal tumor. MATERIALS AND METHODS: Between June 1999 and June 2001, 102 consecutive eligible patients with a computerized tomography identified renal tumor were prospectively randomized to undergo either a transperitoneal (group 1, 50 patients) or retroperitoneal (group 2, 52 patients) laparoscopic radical nephrectomy with intact specimen extraction. Exclusion criteria for the study included body mass index greater than 35 or a history of prior major abdominal surgery in the quadrant of interest. Both groups were matched regarding age (63 versus 65 years, p = 0.69), BMI (29 versus 28, p = 0.89), American Society of Anesthesiologists class (2.7 versus 2.8, p = 0.37), laterality (right side 46% versus 48%, p = 0.85) and mean tumor size (5.3 versus 5.0 cm, p = 0.73). RESULTS: All 102 procedures were technically successful without the need for open conversion. Compared to the transperitoneal approach, the retroperitoneal approach was associated with a shorter time to renal artery control (91 versus 34 minutes, p <0.0001), shorter time to renal vein control (98 versus 45 minutes, p <0.0001) and shorter total operative time (207 versus 150 minutes, p = 0.001). However, the transperitoneal and retroperitoneal approaches were similar in terms of estimated blood loss (180 versus 242 cc, p = 0.13), hospital stay (43 versus 45 hours, p = 0.55), intraoperative complications (10% versus 7.7%, p = 0.30), postoperative complications (20% versus 13.5%, p = 0.14) and postoperative analgesia requirements (27 versus 26 mg MSO4 equivalent p = 0.13). Pathology revealed renal cell carcinoma in 84% and 75% of cases, respectively, with no positive surgical margin in any case. CONCLUSIONS: Laparoscopic radical nephrectomy can be performed efficiently and effectively with the transperitoneal or the retroperitoneal approach. While renal hilar control and total operative time may be quicker with retroperitoneoscopy, the approaches are similar in terms of other patient outcomes evaluated.

Adult↗
PubMed2005

Recurrence and survival following laparoscopic radical nephroureterectomy with various forms of bladder cuff control.

PURPOSE: We document recurrence and survival following laparoscopic radical nephroureterectomy (LNUX) for upper tract transitional cell carcinoma (TCC) using primarily 2 methods of managing the bladder cuff. MATERIALS AND METHODS: The records of 60 patients undergoing LNUX at our institution for upper tract TCC were reviewed retrospectively. En bloc excision of the bladder cuff was primarily performed transvesically by our described cystoscopic secured detachment and ligation method (CDL) or extravesically using a laparoscopic stapling device (LS). RESULTS: Median followup was 23 months (range 1 to 45). Recurrence developed in 27%, 7% and 12% of cases in the bladder at a median of 5 months, retroperitoneum at 8 months and distant sites at 8 months, respectively. Compared to the novel CDL technique LS resulted in a higher positive margin rate (p = 0.046). Overall survival correlated with bladder recurrence (p = 0.003), upper tract TCC stage (p = 0.01) and method of bladder cuff control when comparing CDL vs LS (p = 0.04). Freedom from recurrent upper tract disease was related to pathological stage (p = 0.015) and bladder cuff excision method (p = 0.02). CONCLUSIONS: These data underscore the aggressive nature of high stage, high grade upper tract TCC and validate the importance of complete excision of the distal ureter and bladder cuff during LNUX. In patients without coexisting bladder tumor the CDL method, which allows formal bladder cuff excision in a secured manner akin to that of established open surgical principles, appears oncologically valid.

Aged↗
PubMed2005

Evaluation of the intact specimen after laparoscopic radical nephrectomy for clinically localized renal cell carcinoma identifies a subset of patients at increased risk for recurrence.

PURPOSE: Laparoscopic radical nephrectomy (LRN) is emerging as a standard approach for low stage renal cell carcinoma (RCC). Some suggest that specimen morcellation for extraction results in less morbidity and a faster recovery. However, morcellation may preclude accurate pathological staging and may hinder precise pathological grading. With pathological evaluation of an intact specimen we identified patients harboring high risk disease that was not anticipated preoperatively, defined as pT2 high grade (G3-4) or lesions greater than pT2. MATERIALS AND METHODS: We retrospectively reviewed the records of 192 patients who underwent LRN for renal lesions at The University of Texas M. D. Anderson Cancer Center between April 2002 and April 2004. RESULTS: A total of 192 patients underwent LRN for presumed RCC. In all cases specimens were removed intact. Of these cases 137 were cT1/T2 N0 M0 and had a final pathological diagnosis of RCC. All surgical margins were negative. Of the 137 patients 40 (29.2%) were at increased risk for recurrence based on high risk features. Specifically up staging from cT1-2 to pT3 disease occurred in 30 patients (21.9%) while 12 patients (8.8%) were found to have pT2 G3-4 disease. All 40 patients with high risk disease underwent more intensive surveillance and 17 (43%) participated in adjuvant systemic therapy trials. CONCLUSIONS: In our study 21.9% of patients with clinical T1-2 disease were pathologically up staged and 29.2% were identified as being at high risk for recurrence after intact specimen extraction for localized RCC. These patients are candidates for more intensive followup treatment and may benefit from enrollment in adjuvant therapy protocols.

Carcinoma, Renal Cell↗
PubMed2004

Laparoscopic radical nephroureterectomy: dilemma of the distal ureter.

PURPOSE OF REVIEW: Laparoscopic nephroureterectomy has recently emerged as a safe, minimally invasive approach to upper tract urothelial cancers. The most controversial and challenging feature of laparoscopic nephroureterectomy is the management of the distal ureter. We review the most common methods of managing the distal ureter, with emphasis on contemporary oncologic outcomes, indications, advantages, and disadvantages. RECENT FINDINGS: There are currently in excess of five different approaches to the lower ureter. These techniques often combine features of endoscopic, laparoscopic, or open management. They include open excision, a transvesical laparoscopic detachment and ligation technique, laparoscopic stapling of the distal ureter and bladder cuff, the "pluck" technique, and ureteral intussusception. Each technique has distinct advantages and disadvantages, differing not only in technical approach, but oncological principles as well. While the existing published data do not overwhelmingly support one approach over the others, the open approach remains one of the most reliable and oncologically sound procedures. SUMMARY: The principles of surgical oncology dictate that a complete, en-bloc resection, with avoidance of tumor seeding, remains the preferred treatment of all urothelial cancers. The classical open technique of securing the distal ureter and bladder cuff achieves this principle and has withstood the test of time. Transvesical laparoscopic detachment and ligation is an oncologically valid approach in patients without bladder tumors, but is limited by technical considerations. The laparoscopic stapling technique maintains a closed system but risks leaving behind ureteral and bladder cuff segments. Both transurethral resection of the ureteral orifice (pluck) and intussusception techniques should be approached with caution, as the potential for tumor seeding exists. Additional long-term comparative outcomes are needed to solve the dilemma of the distal ureter.

Humans↗