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4. Correction of Ureteropelvic Junction Obstruction in Children: National Trends and Comparative Effectiveness in Operative Outcomes.

Author

Sukumar, Shyam, Roghmann, Florian, Sood, Akshay, Abdo, Al'a, Menon, Mani, Sammon, Jesse D., Sun, Maxine, Varda, Briony, Trinh, Quoc-Dien, and Elder, Jack S.

Subjects
LAPAROSCOPIC surgery, KIDNEY pelvis, JUVENILE diseases, TREATMENT effectiveness, SURGICAL complications, HOSPITAL charges, DISEASES
Abstract

Purpose: To assess the national trends and comparative effectiveness of the various treatments for pediatric ureteropelvic junction obstruction (UPJO). Patients and Methods: Within the Nationwide Inpatient Sample, a weighted estimate of 35,275 pediatric patients (<19 years; 1998-2010) with UPJO underwent open pyeloplasty (OP), laparoscopic pyeloplasty (LP), robot-assisted pyeloplasty (RP, ≥October 2008) or endopyelotomy (EP). National trends in utilization and comparative effectiveness were evaluated. Results: Minimally invasive pyeloplasty (RP+LP, MIP) utilization began to increase in 2007; MIP accounted for 16.9% of cases (2008-2010). EP accounted for 1.4% of all cases from 1998 to 2010. On individual multivariate models (relative to OP): (a) no significant differences were noted between groups for intraoperative complications; (b) RP and LP had equivalent risks of postoperative complications developing ( vs OP), but EP had a significantly higher risk of postoperative complications; (c) RP and EP had significantly higher risks of necessitating transfusions; (d) RP, LP, and EP had higher overall risks of greater hospital charges; (e) RP had a lower risk of greater length of stay, while EP had a higher risk (LP and OP were equivalent). Conclusions: OP continues to be the predominant treatment for patients with UPJO. RP was the most common MIP modality in every age group. Compared with OP patients, RP patients had equivalent risk for intraoperative and postoperative complications, lower risk for greater length-of-stay, but higher risks for transfusions and greater hospital charges. LP patients had higher overall hospital charges, but no mitigating benefits relative to OP. EP fared poorly on most outcomes. [ABSTRACT FROM AUTHOR]

Published
2014
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5. Pelvic lymph node dissection for prostate cancer: Adherence and accuracy of the recent guidelines.

Author

Abdollah, Firas, Abdo, Al'a, Sun, Maxine, Schmitges, Jan, Tian, Zhe, Briganti, Alberto, Shariat, Shahrokh F, Perrotte, Paul, Montorsi, Francesco, and Karakiewicz, Pierre I

Subjects
*CANCER research, *LYMPH node surgery, *METASTASIS, *DISSECTION, *UROLOGY
Abstract

Objectives The 2004 National Comprehensive Cancer Network practice guidelines recommend pelvic lymph node dissection at radical prostatectomy. We sought to examine the adherence to the 2004 National Comprehensive Cancer Network guidelines and to test the their accuracy, as well as the accuracy of the most contemporary National Comprehensive Cancer Network, American Urological Association, and European Association of Urology guidelines to predict lymph node metastases. Methods A total of 33 037 radical prostatectomy patients were identified, between 2004 and 2006. Adherence to the 2004 National Comprehensive Cancer Network guidelines was calculated using three clinically plausible cut-offs: 2, 5 and 10%. The accuracy was tested using the area under the curve. Results Overall, 63% of patients underwent pelvic lymph node dissection. Of those, 61, 49 and 45% were managed according to the 2004 National Comprehensive Cancer Network guideline cut-off of 2, 5 and 10%, respectively. The accuracy of all the examined guidelines ranged from 61% to 71%. The highest accuracy was recorded for the European Association of Urology and the 2004 National Comprehensive Cancer Network cut-off 5% guidelines. The lowest accuracy was recorded for the most contemporary National Comprehensive Cancer Network guideline. Conclusions Adherence to the 2004 National Comprehensive Cancer Network guidelines was suboptimal. The accuracy of all the examined guidelines ranged from 61% to 71%. None of the examined guidelines can be regarded as an ideal indication for pelvic lymph node dissection. [ABSTRACT FROM AUTHOR]

Published
2013
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6. Racial disparities and socioeconomic status in men diagnosed with testicular germ cell tumors.

Author

Sun, Maxine, Abdollah, Firas, Liberman, Daniel, Abdo, Al'a, Thuret, Rodolphe, Tian, Zhe, Shariat, Shahrokh F., Montorsi, Francesco, Perrotte, Paul, and Karakiewicz, Pierre I.

Subjects
CANCER research, RACIAL differences, SOCIOECONOMIC factors, TESTICULAR cancer, GERM cell tumors, AFRICAN American men, DISEASES
Abstract

BACKGROUND: Previous reports indicated that African-American men with testicular germ cell tumors (TGCTs) have more aggressive tumor characteristics and less favorable outcomes than other men. The authors of this report evaluated the effects of race and socioeconomic status (SES) on stage distribution, overall mortality (OM), and cancer-specific mortality (CSM) in men with TGCTs. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 22,553 men who were diagnosed with TGCTs between 1988 and 2006. Kaplan-Meier and Cox regression analyses were generated to predict OM and CSM. Covariates of the analyses included race, SES, age, histologic subtype, disease stage, procedure type, SEER registry, and year of diagnosis. The interaction between race and SES also was examined. RESULTS: Overall, there were 516 African-American men, 21,090 Caucasian men, and 947 men of other races. African-Americans (14.9%) and individuals with low SES (10.7%) had a higher proportion of distant stage disease. CSM and OM rates were significantly higher for African-American patients and for patients who resided in low SES counties. Multivariate analyses revealed that African-American men and men with low SES were more likely to die of OM and CSM relative to Caucasian men ( P < .001) and men with high SES ( P < .001), respectively. The interaction between race and SES was not significant. CONCLUSIONS: African-American race and low SES appeared to predispose men to more advanced disease stages and to higher OM and CSM rates. These observations may warrant race-specific and/or SES-specific adjustments in the treatment of TGCT. Cancer 2011;. © 2011 American Cancer Society. [ABSTRACT FROM AUTHOR]

Published
2011
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31. A population-based assessment of the National Comprehensive Cancer Network practice guideline indications for pelvic lymph node dissection at radical prostatectomy.

Author

Abdollah, Firas, Schmitges, Jan, Sun, Maxine, Shariat, Shahrokh F., Briganti, Alberto, Abdo, Al'a, Tian, Zhe, Perrotte, Paul, Montorsi, Francesco, and Karakiewicz, Pierre I.

Subjects
CANCER patients, NOMOGRAPHY (Mathematics), HUMAN dissection, CANCER invasiveness, METASTASIS, PROSTATECTOMY, LYMPH node cancer
Abstract

Study Type - Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The National Comprehensive Cancer Network guidelines recommend pelvic lymph node dissection in patients with a nomogram-predicted lymph node invasion risk of 2% or more. We set out to examine the validity of this recommendation. OBJECTIVES [ABSTRACT FROM AUTHOR]

Published
2012
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