http://hdl.handle.net/2027.42/78567 2013-06-18T21:17:28Z http://hdl.handle.net/2027.42/78157 A Multi-Institutional Study on the Safety and Efficacy of Specimen Morcellation After Laparoscopic Radical Nephrectomy for Clinical Stage T1 or T2 Renal Cell Carcinoma Wu, Simon D.; Lesani, O. Alex; Zhao, Lee C.; Johnston, William K.; Wolf, J. Stuart; Clayman, Ralph V.; Nadler, Robert B. Abstract Introduction and Objective: Specimen morcellation during laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) is controversial. We seek to evaluate the safety and efficacy of specimen morcellation and LRN for treatment of presumed malignant renal lesions. Methods: We retrospectively reviewed all patients who underwent LRN at three academic institutions from 1996 to 2007. One hundred eighty-eight patients underwent specimen morcellation after LRN for enhancing solid or cystic renal masses. Results: LRN was successfully performed on all the patients. Patient age ranged from 36 to 94. One hundred sixty-seven patients were in clinical stage T1, 19 patients T2, and unknown in two. The specimen was manually morcellated within a Cook Lap Sac or Endocatch II bag under laparoscopic or direct observation. On histological review of morcellated specimens, 165 patients were confirmed to have RCC, 17 had an oncocytoma, and 2 had benign cysts. At least 13 patients with RCC were pathologically upgraded to stage T3. Mean operative time was 225 minutes (range 94-650). Mean hospital stay was 2.5 days (range 1-8). In patients with RCC, 11 developed recurrent disease with mean follow-up of 21 months (range 0.3-111). In one patient, a port site recurrence occurred in concert with renal fossa and lymph node metastases. Conclusions: Intracorporeal mechanical morcellation after LRN appears to be safe and effective in clinical stage T1 and T2 RCC. This supports the use of morcellation as an alternative for intact specimen removal in properly selected patients. 2009-09-01T00:00:00Z http://hdl.handle.net/2027.42/78145 Change in Markers of Bone Metabolism with Chemotherapy for Advanced Prostate Cancer: Interleukin-6 Response Is a Potential Early Indicator of Response to Therapy Woods Ignatoski, Kathleen M.; Friedman, Judah; Escara-Wilke, June; Zhang, Xiaohua; Daignault, Stephanie; Dunn, Rodney L.; Smith, David C.; Keller, Evan T. Men with androgen-independent prostate cancer (AIPC) frequently have bone metastasis. The effects of chemotherapy on markers of bone metabolism have not been well characterized. We conducted a prospective study of patients with AIPC randomized in the first cycle to receive either docetaxel/estramustine or zoledronic acid, a bisphosphonate, to inhibit osteoclastic activity. Here we report the effects of therapy on markers of bone metabolism in these patients following the first cycle of therapy. Serum levels of several indices of bone remodeling were evaluated using commercial enzyme-linked immunosorbent assays. Changes in markers of bone metabolism were compared in patients receiving initial chemotherapy versus bisphosphonate. There was no significant difference in median change in any of the measured bone markers in patients given zoledronic acid when compared to chemotherapy. When comparing responders to nonresponders, overall interleukin-6 (IL-6) decreased by 35% in prostate-specific antigen responders; whereas, IL-6 levels increased by 76% in nonresponders (p = 0.03). Elevated IL-6 levels and reductions in IL-6 levels early in treatment may reflect ultimate clinical response to docetaxel-based regimens. 2009-02-01T00:00:00Z http://hdl.handle.net/2027.42/78122 Single-Setting Bilateral Hand-Assisted Laparoscopic Partial Nephrectomy Madi, Rabii; Wolf, J. Stuart Abstract Purpose: To assess the feasibility and safety of single-setting bilateral hand-assisted laparoscopic partial nephrectomy. Materials and Methods: Between August 2003 and June 2004, we performed single-setting bilateral laparoscopic partial nephrectomies on three patients. A hand-assisted approach was used, employing the same hand-assistance incision for both sides. Renal hilar clamping was not required, as the depth of penetration of all six tumors was only 0 to 4mm (mean, 1.8mm). The tumor diameters ranged from 1.8 to 3.8cm (mean, 2.4cm). Results: All operations were performed successfully, with no conversion to open surgery. Excision was performed with bipolar forceps, and final hemostasis was obtained with an argon beam coagulator (Valleylab, Boulder, CO) and Floseal (Baxter, Deerfield, IL), without suturing. The mean estimated blood loss was 208mL. The mean operative time was 246 minutes, which included repositioning. There were no intraoperative complications, and the postoperative course was uneventful in all patients except for a hospital stay of 5 days in one patient owing to transient ileus. Pathology revealed a benign lesion on one side and renal cell carcinoma on the other side in two patients, and bilateral leiomyomas in one patient. All margins of resection were negative, and neither of the two patients with cancer has had recurrence at a mean follow-up of 51 months. Among all three patients, the mean preoperative serum creatinine was 0.9mg/dL, and the average level at a mean of 35 months postoperatively was 1.0mg/dL. Conclusion: Single-setting bilateral hand-assisted laparoscopic partial nephrectomies can be safely and effectively performed on patients with bilateral small exophytic kidney tumors. We do not recommend this technique if both kidneys require temporary hilar occlusion, but it can be considered if only one kidney requires hilar occlusion. 2009-06-01T00:00:00Z http://hdl.handle.net/2027.42/78109 Convenient Creation and Use of Suturing Supplies for Laparoscopic Partial Nephrectomy Wolf, J. Stuart Abstract The closure of the renal defect is the most challenging part of laparoscopic partial nephrectomy when suturing is required. The author presents a method of creating and using suturing material for laparoscopic partial nephrectomy that has been developed over several hundred cases at the author's institution. These techniques can be used to simplify the task of suturing during laparoscopic partial nephrectomy. 2009-07-01T00:00:00Z