Japanese Nationwide Database Research Articles

Increasing risk of postoperative daily-activity damage with aging on prostatectomy, nephrectomy, nephroureterectomy and cystectomy: Japanese nationwide database

Increasing risk of postoperative daily-activity damage with aging on prostatectomy, nephrectomy, nephroureterectomy and cystectomy: Japanese nationwide database

Impact of Drain Insertion After Perforated Peptic Ulcer Repair in a Japanese Nationwide Database Analysis.

Many perforated peptic ulcers (PPUs) require surgical repair due to diffuse peritonitis. However, few studies have examined the clinical effects of postoperative drainage after PPU repair. This study aimed to investigate the drain insertion rates in patients who underwent PPU repair in Japan, and to clarify the impact of drain insertion on the postoperative clinical course. A retrospective nationwide cohort study was performed using administrative claims data of patients who had undergone PPU repair between 2010 and 2016. These patients were divided into two groups based on whether or not they had received a postoperative abdominal drain. Using propensity score matching, we compared the incidences of postoperative interventions for abdominal complications between both groups. A total of 4869 patients from 324 hospitals were analyzed. At the hospital level, drains were placed in all PPU repair patients in 229 (70.7%) hospitals. At the patient level, 4401 patients (90.4%) had drains inserted. The drain group was associated with a higher emergency admission rate, poorer preoperative shock status, longer anesthetic time, and a higher amount of intra-abdominal irrigation. In the propensity score-matched patients, the drain group had a significantly lower incidence of postoperative interventions than the no-drain group (1.9 vs. 5.6%; risk ratio=0.35; 95% confidence interval 0.16-0.73; P=0.003). Postoperative drainage was performed in the majority of patients who underwent PPU repair in Japan. Drainage following PPU repair may facilitate patient recovery by reducing the need for postoperative interventions.

Outcomes of Allogeneic Hematopoietic Cell Transplantation in Acute Myeloid Leukemia Patients with Abnormalities of the Short Arm of Chromosome 17

We retrospectively analyzed a Japanese nationwide database to elucidate the impact of abnormalities in the short arm of chromosome 17 (abnl[17p]) on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia. Of 10,923 patients, 262 (2.4%) had abnl(17p), 235 of whom were classified into the poor cytogenetic risk group according to the National Comprehensive Cancer Network criteria. The median follow-up period was 1425 days. In abnl(17p) versus non-abnl(17p) patients of poor cytogenetic risk group, overall survival (OS), disease-free survival, cumulative incidence of disease relapse, and nonrelapse mortality rates at 5 years after allo-HSCT were 9.2% versus 27.4%, 7.8% versus 25.0%, 66.6% versus 49.4%, and 25.6% versus 25.6%, respectively. In contrast to the other types of abnl(17p), isochromosome 17q rarely encompassed the poor cytogenetic risk traits and did not adversely affect OS. Among the abnl(17p) patients, male sex, nonremission disease status at transplantation, and poor cytogenetic risk group were significantly associated with shorter OS. In conclusion, the presence of an abnl(17p) negatively affects allo-HSCT outcomes, which are influenced by the type of abnormality. Prompt initiation of allo-HSCT during complete remission may improve outcomes.

Development and external validation of preoperative risk models for operative morbidities after total gastrectomy using a Japanese web-based nationwide registry

BackgroundTotal gastrectomy is a relatively difficult and invasive procedure among gastrointestinal surgeries, and major morbidities following total gastrectomy can be serious and fatal. This study aimed to develop and validate preoperative risk models of morbidities associated with total gastrectomy using a Japanese web-based nationwide registry.MethodsThe national clinical database was used to retrieve the records of 39,253 patients who underwent total gastrectomy in 1,841 hospitals between January 1, 2011 and December 31, 2012.ResultsMean patient age was 69.1 years, and 73.8% of the patients were male. The overall morbidity rate was 21.5%, which included 8.1% with surgical site infection (SSI), 4.5% with anastomotic leak, 5.0% with pancreatic fistula, 3.7% with pneumonia, 1.9% with prolonged ventilation, and 1.2% with renal failure. Sex, splenectomy, and Brinkman index were selected as common risk factors for SSI, anastomotic leak, and pancreatic fistula. Pancreatectomy was the most significant preoperative risk factor in the risk model of SSI and pancreatic fistula. Need of assistance with activities of daily living, chronic obstructive pulmonary disease, previous cerebrovascular disease, American Society of Anesthesiologists score class 3 and over, presence of esophageal cancer, and body mass index more than 25 were selected as common risk factors for pneumonia, prolonged ventilation over 48 h, and renal failure.ConclusionsWe have created the first reported risk models of morbidities associated with total gastrectomy, using a Japanese nationwide database. The risk models developed in this study may be useful to preoperatively predict operative morbidities in patients undergoing total gastrectomy.

Sivelestat sodium and mortality in pneumonia patients requiring mechanical ventilation: propensity score analysis of a Japanese nationwide database.

Sivelestat is widely used in Japan for the treatment of acute respiratory distress syndrome caused by pneumonia. Although the efficacy of sivelestat was reported in several Japanese studies in the early 2000s, a multinational randomized control trial did not support these findings. We therefore conducted the present study to examine the association between the use of sivelestat and mortality in pneumonia patients requiring mechanical ventilation. We conducted a retrospective observational study using the Diagnosis Procedure Combination database, a national inpatient database in Japan. We identified pneumonia patients requiring mechanical ventilation who were hospitalized between April 2012 and March 2014. Propensity score matching was performed to compare 7- and 30-day mortality between patients with and without sivelestat use. The eligible patients (n=16,471) were categorized into the sivelestat (n=1707) and control (n=14,764) groups. The unmatched comparison showed significant differences between the sivelestat and control groups in both 7-day mortality (11.0 vs. 7.6%, p<0.001) and 30-day mortality (29.9 vs. 19.7%, p<0.001). In the 1516 pairs of propensity-matched patients, there were no significant differences in 7-day mortality (sivelestat vs. 10.2 vs. 10.9%, p=0.516) and 30-day mortality (sivelestat vs. control 29.0 vs. 29.0%, p=1.000). The propensity-matched analyses revealed that the use of sivelestat was not associated with decreased mortality for pneumonia patients requiring mechanical ventilation.

A phase I/II trial of intrabone marrow cord blood transplantation and comparison of the hematological recovery with the Japanese nationwide database

Intrabone marrow cord blood transplantation (IB-CBT) was proposed as a promising treatment modality to improve hematological recovery. However, clinical advantages of IB-CBT over conventional IV CBT have been unclear. We conducted a prospective single-center trial of IB-CBT to evaluate its safety and superiority in terms of hematological recovery. Fifteen adults with hematological malignancies were enrolled. A thawed and unwashed single cord blood unit was injected into the bilateral superior-posterior iliac crests under local anesthesia. Engraftments of neutrophils and platelets were achieved in 13 cases, with medians of 17 and 45 days, respectively. For the control, we extracted data from the Japanese nationwide database and compared the hematological recovery of contemporaneously transplanted 1135 CBT cases. Multivariate analysis revealed that IB-CBT enhanced platelet recovery (hazard ratio, 2.13; P=0.007), but neutrophil recovery did not differ significantly (hazard ratio, 1.70; P=0.19). Better donor chimerism was seen in the bone marrow of the ilium than of the sternum on day 14, suggesting that the local hematopoiesis at the injected site was established earlier than that at the remote bone marrow site. Collectively, IB-CBT was well tolerated and may enhance local engraftment, which promotes prompter platelet recovery than does IV-CBT.

ED15.03 Surgery of Thymic Malignancies

ED15.03 Surgery of Thymic Malignancies

Prophylactic Antibiotics May Improve Outcome in Patients With Severe Burns Requiring Mechanical Ventilation: Propensity Score Analysis of a Japanese Nationwide Database.

The use of prophylactic antibiotics for severe burns in general settings remains controversial and is not suggested by recent guidelines owing to lack of evidence for efficacy. We examined the hypothesis that prophylactic systemic antibiotic therapy may reduce mortality in patients with severe burns. We identified 2893 severe burns patients (burn index ≥ 10) treated at 583 hospitals between July 2010 and March 2013 using the Japanese diagnosis procedure combination inpatient database. We categorized the patients according to whether they received mechanical ventilation within 2 days after admission (n = 692) or not (n = 2201). We further divided the patients into those with and without prophylactic antibiotics and generated 232 and 526 propensity score-matched pairs, respectively. We evaluated 28-day all-cause in-hospital mortality. Among the mechanically ventilated patients, significant differences in 28-day in-hospital mortality existed between control and prophylaxis groups in both unmatched (control vs prophylaxis; 48.6% vs 38.3%; difference, 10.2%; 95% confidence interval [95% CI], 2.7 to 17.7) and propensity score-matched groups (47.0% vs 36.6%; difference, 10.3%; 95% CI, 1.4 to 19.3). Among patients without mechanical ventilation, there was no significant difference in 28-day in-hospital mortality between the 2 groups in both the unmatched (control vs prophylaxis; 7.0% vs 5.8%; difference, 1.2%; 95% CI, -1.2 to 3.5) and propensity-matched groups (5.1% vs 4.2%; difference, 0.9%; 95% CI, -1.6 to 3.5). Prophylactic antibiotics use may result in improved 28-day in-hospital mortality in mechanically ventilated patients with severe burns but not in those who do not receive mechanical ventilation.

Surgical Outcomes of Patients With Stage III Thymoma in the Japanese Nationwide Database

To investigate the clinical characteristics and therapeutic outcomes of patients who underwent surgery for stage III thymoma in Japan. Using the Japanese nationwide database, which contains the records of 2,835 patients with thymic epithelial tumors who underwent treatment between 1991 and 2010, we extracted and analyzed the records of those who underwent surgery for stage III thymoma. A total of 310 patients (170 males, 140 females; median age, 58 years) were analyzed. Involved sites were the lung in 194 (62.6%), the pericardium in 151 (48.7%), the great vessels in 126 (40.6%), the phrenic nerve in 84 (27.1%), and the chest wall in 7 (2.3%). Complete resection (R0) was achieved in 247 (79.7%) cases. Induction therapies were administered to 42 (13.5%) patients, and postoperative therapies were administered to 147 (47.4%). In R0 cases, 68 (27.5%) experienced recurrence. The pleural space was the most frequent site of recurrence (46; 18.6%). The 10-year overall and disease-free (in R0) survival rates were 80.2% and 51.6%, respectively. Multivariate analyses revealed that age (p= 0.002), male sex (p= 0.017), induction therapy (p < 0.001), and type B histology (p= 0.037) were independent adverse predictors for overall survival. Chest wall invasion was the only independent adverse predictor for disease-free survival, although the factor analysis was marginal for overall survival. The outcomes of surgery for patients with stage III thymoma were favorable unless chest wall invasion was present; however, the role of complete resection and appropriate multimodal treatment plan require further investigation.

Risk Models of Operative Morbidities in 16,930 Critically Ill Surgical Patients Based on a Japanese Nationwide Database.

The aim of the study was to evaluate preoperative variables predictive of lethal morbidities in critically ill surgical patients at a national level.There is no report of risk stratification for morbidities associated with mortality in critically ill patients with acute diffuse peritonitis (ADP).We examined data from 16,930 patients operated during 2011 and 2012 in 1546 different hospitals for ADP identified in the National Clinical Database of Japan. We analyzed morbidities significantly associated with operative mortality. Based on 80% of the population, we calculated independent predictors for these morbidities. The risk factors were validated using the remaining 20%.The operative mortality was 14.1%. Morbidity of any grade occurred in 40.2% of patients. Morbidities correlated with mortality, including septic shock, progressive renal insufficiency, prolonged ventilation >48 hours, systemic sepsis, central nervous system (CNS) morbidities, acute renal failure and pneumonia, and surgical site infection (SSI), were selected for risk models. A total of 18 to 29 preoperative variables were selected per morbidity and yielded excellent C-indices for each (septic shock: 0.851; progressive renal insufficiency: 0.878; prolonged ventilation >48 h: 0.849; systemic sepsis: 0.839; CNS morbidities: 0.848; acute renal failure: 0.868; pneumonia: 0.830; and SSI: 0.688).We report the first risk stratification study on lethal morbidities in critically ill patients with ADP using a nationwide surgical database. These risk models will contribute to patient counseling and help predict which patients require more aggressive surgical and novel pharmacological interventions.

Long-term outcome and prognostic factors of surgically treated thymic carcinoma: results of 306 cases from a Japanese Nationwide Database Study.

Thymic carcinoma is a rare thymic malignancy. The purpose of this study was to evaluate the prognostic impact of clinicopathological variables and perioperative therapy for surgically treated thymic carcinoma using a nationwide database. Of 2835 patients with surgically treated thymic epithelial tumours collected from 32 Japanese institutions, a total of 306 patients with thymic carcinomas, excluding neuroendocrine tumours, were enrolled in this retrospective study. Multivariable Cox regression analyses were performed for overall (OS) and recurrence-free survival (RFS) after R0 resection. Of 306 patients, 228 (75%) patients presented with Masaoka stage III-IV. Squamous cell carcinoma was the most common histological type (n = 216, 71%). R0 resection was performed in 181 (61%) patients, R1 in 46 (16%), R2 sub-total (≥80% tumour resection) in 43 (14%) and R2 non-resection in 27 (9%). The 5-year OS rate was 61%. Prognostic factors for OS were Masaoka stage and resection status. R0 resection was associated with most improved OS; however, both R1 and R2 sub-total resection resulted in superior OS compared with R2 non-resection [hazard ratio (95% confidence interval) for R0, R1 and R2 sub-total, 0.27 (0.15-0.48), 0.40 (0.22-0.74) and 0.38 (0.20-0.72), respectively]. Histological type and perioperative therapy did not affect OS, whereas tumour size and postoperative radiotherapy were associated with improved RFS after R0 resection. R0 resection is essential for prolonged OS for surgically treated thymic carcinoma, but maximal debulking surgery might be beneficial and worth evaluating for advanced disease deemed difficult for R0 resection. The benefit of postoperative radiotherapy after R0 resection should also be evaluated prospectively.

Blood pressure and left ventricular mass index in healthy adolescent athletes

The increased prevalence of chronic kidney disease (CKD) is a consequence of the accumulation of risk factors, one of which is hypertension. Here we assessed the prevalence of CKD according to blood pressure among 232,025 patients in a Japanese nationwide database with a focus on the prevalence and risk factors of CKD in prehypertension. Patients were stratified by blood pressure and included 75,474 with optimal blood pressure (less than 120/80 mm Hg); 59,194 with prehypertension and a normal blood pressure (120–129/80–84 mm Hg) or 46,547 patients with high-normal blood pressure (130–139/85–89 mm Hg); and 50,810 with hypertension (over 140/90 mm Hg without anti-hypertensive drugs). CKD was defined as an estimated glomerular filtration rate of stage 3 or lower or having proteinuria greater than 1+ by a dipstick method. The prevalence of CKD among patients with optimal blood pressure, prehypertension having normal or high-normal blood pressure, and hypertension was 13.9, 15.6, 18.1, and 20.7% in men, and 10.9, 11.6, 12.9, and 15.0% in women, with a significant difference between genders at each strata of blood pressure. In men, but not in women, whose blood pressure was high-normal, the CKD risk was significantly greater (odds ratio 1.11) than those with optimal blood pressure. Obesity (body mass index over 25) was significantly associated with an increased risk of CKD in both men and women (odds ratio 1.43 and 1.26, respectively), and there was an additive effect of obesity and pre-hypertension on CKD risk in men compared with men with optimal blood pressure. Thus, the prevalence of CKD increased with the severity of blood pressure. Prehypertension with high-normal blood pressure, particularly in conjunction with obesity, was found to be an independent risk factor of CKD in men.

Geographical analysis of aneurysmal subarachnoid hemorrhage in Japan utilizing publically-accessible DPC database.

Since the launch of the novel medical reimbursement system Diagnosis Procedure Combination (DPC) in 2003 in Japan, inpatient data has been accumulated over time as part of a Japanese governmental nationwide database. This is partially accessible by the public, and this study examined the adequacy of this database as epidemiological research material by extracting the data relating to aneurysmal subarachnoid hemorrhage (aSAH) with special attention given to the limitations that this involves. Datasets after 2010 are considered suitable for analysis because of the numbers of participating hospitals and the analysis term. Extracting the data by prefecture, those with a continuously high aSAH incidence were Aomori, Iwate, Akita, Yamagata, Kochi and Kumamoto Prefectures, and those with low aSAH incidence were Kanagawa, Shiga, Kyoto, Shimane and Ehime Prefectures. Although these obtained results are informative, a publically-accessible DPC database has several limitations. Some limitations have been resolved: the analyzed term each year is now 12-months and the number of participating hospitals seems to have stabilized around 1700. However, other limitations such as masking the numbers in each hospital reporting less than 10 patients still exist, so careful and critical interpretation is necessary in utilizing a publically-accessible DPC database. Considering the potential of this database as material for epidemiological research, future analysis of the entire DPC database by qualified researchers is desirable.

Current state of continuous renal replacement therapy for acute kidney injury in Japanese intensive care units in 2011: analysis of a national administrative database.

Nationwide data for the prevalence and outcomes of patients receiving continuous renal replacement therapy (CRRT) in intensive care units (ICUs) are scarce. This study assessed the status of CRRT in Japanese ICUs using a nationwide administrative claim database. Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. From a cohort of critically ill patients aged 12 years or older who were admitted to ICUs for 3 days or longer, acute kidney injury (AKI) patients treated with CRRT were identified. The period prevalence of CRRT and in-hospital mortality were calculated. Logistic regression analysis identified factors associated with in-hospital mortality. Of 165 815 ICU patients, 6478 (3.9%) received CRRT for AKI. The most frequent admission diagnosis category was diseases of the circulatory system (n = 3074). The overall in-hospital mortality rate of the CRRT-treated AKI patients was 50.6%. Clustering patients into four groups by background revealed the lowest in-hospital mortality rate of 41.5% for the cardiovascular surgery group (n = 1043) compared with 53.5% for the nonsurgical cardiovascular group (n = 2031), 51.7% for the sepsis group (n = 1863) and 51.6% for other cases (n = 1541). Multiple logistic regression analysis showed a significant association of these four group classifications with in-hospital mortality in addition to age, hospital characteristics (type and volume), time from hospital admission to CRRT initiation and interventions performed on the day of CRRT initiation. Using a large Japanese nationwide database, this study revealed remarkably high in-hospital mortality of CRRT-treated AKI patients, although the period prevalence of CRRT for AKI in ICUs was low.

Surgical Management of Recurrent Thymic Epithelial Tumors: A Retrospective Analysis Based on the Japanese Nationwide Database

There is no standard treatment for recurrent thymic epithelial tumors. Although the efficacy has not been validated based on the large series studies, surgical resection is sometimes employed for patients with recurrent thymic tumors. The aim of this study is to evaluate the surgical outcomes for recurrent thymic epithelial tumors based on the Japanese nationwide database. From the database of patients whose thymic epithelial tumors were treated surgically from 1991 through 2010, the cohort who developed recurrence after the initial resection was extracted. Clinicopathological factors were reviewed, and the prognostic factors of re-resected cases were examined. Twenty-eight hundred thirty-five patients who underwent surgical resection of thymic epithelial tumors were registered to the database. Among these patients, 420 (14.8%) experienced recurrence. One hundred sixty-two patients were treated surgically and 243 were treated nonsurgically for recurrent disease. The 5- and 10-year postrecurrence survival rates were 82.7% and 68.2%, respectively, in the surgery group and 43.5% and 25.4%, respectively, in the nonsurgery group (p < 0.001). According to univariate analyses, female sex and the pathological Masaoka I-II stage, nonthymic carcinoma, absence of preoperative treatment and longer recurrent-free interval (RFI) were significantly favorable factors for survival in the surgery group. According to the multivariate analysis, nonthymic carcinoma histology and longer RFI were identified to be independent prognostic factors. The surgical outcomes of recurrent thymic epithelial tumors are favorable in selected patients. The role of re-resection may be limited in the setting of thymic carcinoma and/or a short RFI.

Long-term outcomes of combined androgen blockade therapy in stage IV prostate cancer.

To clarify which subset of stage IV prostate cancer patients benefit from combined androgen blockade (CAB) using Japanese nationwide database. A total of 3,752 patients with stage IV disease from the prospective nationwide cohort database of the Japan Study Group of Prostate Cancer (J-CaP) were enrolled. All patients started primary androgen deprivation therapy (PADT) between 2001 and 2003, and the present study was performed using the data set from December 2011. Patients were divided into two groups according to initial treatments: CAB with luteinizing hormone-releasing hormone agonist (LHRH) plus anti-androgen (AA) and non-CAB treatments such as LHRH monotherapy. The overall survival (OS) and cancer-specific survival (CSS) for each group were estimated by the Kaplan-Meier method. A total of 2,967 patients (79.1%) received CAB. Overall, no significant difference was observed in OS and CSS between the CAB group and the non-CAB group. However, CAB resulted in significantly better OS and CSS compared to non-CAB in patients with very high Japan Cancer of the Prostate Risk Assessment (J-CAPRA) scores of ten or greater (P = 0.007 and 0.013, respectively). Multivariate analysis revealed that CAB was an independent predictive factor for better OS (P = 0.013, hazard ratio = 0.83). Based on large-scale nationwide database, as PADT for prostate cancer patients with very high-risk disease, CAB resulted in better OS than other endocrine treatments.

Surgical risk model for acute diffuse peritonitis based on a Japanese nationwide database: an initial report on the surgical and 30-day mortality

Acute diffuse peritonitis (ADP) is an important surgical complication associated with high morbidity and mortality; however, the risk factors associated with a poor outcome have remained controversial. This study aimed in collecting integrated data using a web-based national database system to build a risk model for mortality after surgery for ADP. We included cases registered in the National Clinical Database in Japan. After data cleanup, 8,482 surgical cases of ADP from 1,285 hospitals treated between January 1 and December 31, 2011 were analyzed. The raw 30-day and surgical mortality rates were 9.0 and 14.1 %, respectively. The odds ratios (>2.0) for 30-day mortality were as follows: American Society of Anesthesiologists (ASA) class 3, 2.69; ASA class 4, 4.28; ASA class 5, 8.65; previous percutaneous coronary intervention (PCI), 2.05; previous surgery for peripheral vascular disease (PVD), 2.45 and disseminated cancer, 2.16. The odds ratios (>2.0) for surgical mortality were as follows: ASA class 3, 2.27; ASA class 4, 4.67; ASA class 5, 6.54, and disseminated cancer, 2.09. The C-indices of 30-day and surgical mortality were 0.851 and 0.852, respectively. This is the first report of risk stratification after surgery for ADP using a nationwide surgical database. This system could be useful to predict the outcome of surgery for ADP and for evaluations and benchmark performance studies.

A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database.

This study aimed to create a risk model of mortality associated with esophagectomy using a Japanese nationwide database. A total of 5354 patients who underwent esophagectomy in 713 hospitals in 2011 were evaluated. Variables and definitions were virtually identical to those adopted by the American College of Surgeons National Surgical Quality Improvement Program. The mean patient age was 65.9 years, and 84.3% patients were male. The overall morbidity rate was 41.9%. Thirty-day and operative mortality rates after esophagectomy were 1.2% and 3.4%, respectively. Overall morbidity was significantly higher in the minimally invasive esophagectomy group than in the open esophagectomy group (44.3% vs 40.8%, P = 0.016). The odds ratios for 30-day mortality in patients who required preoperative assistance in activities of daily living (ADL), those with a history of smoking within 1 year before surgery, and those with weight loss more than 10% within 6 months before surgery were 4.2, 2.6, and 2.4, respectively. The odds ratios for operative mortality in patients who required preoperative assistance in ADL, those with metastasis/relapse, male patients, and those with chronic obstructive pulmonary disease were 4.7, 4.5, 2.3, and 2.1, respectively. This study was the first, as per our knowledge, to perform risk stratification for esophagectomy using a Japanese nationwide database. The 30-day and operative mortality rates were relatively lower than those in previous reports. The risk models developed in this study may contribute toward improvements in quality control of procedures and creation of a novel scoring system.

IJU this Issue

This issue contains one Review Article, nine Original Articles and three Short Communications. Sung et al. (Seoul, Korea) reviewed robot-assisted surgery in the field of female urology. The authors introduced new techniques using robotic surgery for the management of pelvic organ prolapse and lower urinary tract fistulas. Intra-corporeal suturing and accurate pelvic dissection will be required for the laparoscopic management of these disorders. These techniques can be carried out easily and accurately in robot-assisted surgery. Robot-assisted repairs might be offered for the treatment of pelvic organ prolapse or lower urinary tract fistulas. Lymphocele is one of the common postoperative complications of pelvic lymph node dissection (PLND). Lee et al. (Seoul, Korea) investigated the incidence of lymphocele after extraperitoneal robot-assisted radical prostatectomy (RARP) and PLND. The authors carried out magnetic resonance imaging (MRI) routinely at 3 or 4 months after RARP. A total of 483 patients underwent extraperitoneal RARP, and 200 patients (41.4%) underwent PLND. Lymphocele was detected in 41 (20.5%) patients. Seminal vesicle invasion (SVI, P = 0.015) and tumor volume (P = 0.042) were significantly different between the two groups. In the multivariate analysis, extracapsular extension (ECE; P = 0.017, odds ratio [OR] 4.231), SVI (P = 0.028, OR 2.643) and the number of positive lymph nodes (P = 0.041, OR 3.532) were independent risk factors. They concluded that ECE, SVI and the number of positive lymph nodes are independent risk factors for postoperative lymphocele after extraperitoneal RARP with PLND. From another viewpoint, lymphocele development might be a prognostic factor of prostate cancer patients who undergo RARP and PLND. Many methods of prostate cancer screening have been evaluated to be more effective than basic screening. De Coninck et al. (Brussels, Belgium) evaluated prostate histoscanning (PHS) as a new method for screening. PHS is a computer-aided ultrasonography, and the data obtained from the transrectal ultrasound were processed. A special volumetric tool provided total prostate volume and total tumor lesion volume. The authors devised the algorithm of prostate cancer screening using PHS. A total of 94 cases were examined with PHS, and 41 cases were referred for prostate biopsy under computer-aided ultrasonographic guidance. A tumor volume increase of 1 mL estimated by PHS was associated with the probability of a positive biopsy (OR 2.9, 95% confidence interval 1.2–7.0, P = 0.02). Prostate cancer was found in 17 men (41%), and the cancer detection rate for random biopsy and directed biopsy was 13% and 58%, respectively. PHS might be helpful for the selection of patients in whom prostate biopsies are necessary. Percutaneous nephrolithotomy (PCNL) is a popular treatment for renal calculi greater than 2 cm or staghorn calculi. Sugihara et al. (Tokyo, Japan) investigated the risk factors of severe adverse events (sAE) after PCNL from the data of 1511 cases from the Japanese nationwide database. A total of 126 (8.34%) sAE were identified. In the multivariate analysis, a linear trend between sAE and operation time was observed (OR 4.72 for 120–179 min to OR 17.95 for ≥300 min, compared with ≤119 min, P < 0.05). Female sex (OR 1.92) and emergency admission (OR 2.04) were also identified. The authors concluded that longer operation time was a salient risk factor for sAE after PCNL. It is important to inform patients of these data and also to prevent sAE. To shorten the operating time, well-planned and careful procedures are required. There were some reports that examined prostate cancer reduction by α-1 adrenoceptor antagonist. Yamada et al. (Tokyo, Japan) investigated the effects of naftopidil, an α1-adrenoceptor antagonist, and transforming growth factor-β to reduce prostate cancer incidence. The men who continued naftopidil (n = 766) or tamsulosin (n = 1015) for 3 months or longer were evaluated. Prostate cancer incidence was significantly lower in men who received naftopidil compared with tamsulosin for 3 months or longer (14; 1.8% vs 32; 3.1%, P = 0.035), remains in multivariate analysis (P = 0.013). The authors also evaluated cell viability and apoptosis in prostate cancer cells, and the effect of naftopidil or tamsulosin. Naftopidil inhibited cell growth, induced apoptosis and blocked Smad2 phospholilation activated by transforming growth factor-β. These results suggest the effect of naftopidil as chemoprevention for prostate cancer. None declared.

Abstract 203: Potential Dependence on Type of Bystander Basic Life Support Response and Outcomes in Out-of-Hospital Cardiac Arrests Managed Without Any Involvement of Physicians

Objectives: The present study was conducted to test our hypothesis that relation of bystander to cardiac arrest victim may affect the BLAs response and outcomes in bystander-witnessed OHCAs. Methods: We obtained the Japanese nation-wide database for 547,218 OHCAs that occurred from Jan. 2005 to Dec. 2009, and extracted a dataset for 139,265 bystander-witnessed OHCAs without any involvement of physicians, that has all information for analysis. We first compared the BLS response of the four bystander groups (family members, friends and colleagues, passers-by and others). Then, we compared the outcomes of bystander-witnessed OHCAs having bystander CPR among the four groups. Results: The intervals between collapse and emergency call and between call and arrival at patient were shortest in OHCAs witnessed by pass-by. The telephone-CPR was most frequently attempted (45.8%, 41,442/90,426) but failed (39.4%, 16,315/41,442) in OHCAs witnessed by family. Consequently, the rate of bystander CPR was lowest (36.5%, 33,008/90,426), CPR was most frequently initiated following the telephone-CPR (76.1%, 25,127/33,008), and type of CPR was most frequently “chest-compression-only” (67.9%, 22,406/33,008) in OHCAs witnessed by family members. Multiple logistic regression analysis revealed that family as a type of bystander was an independent factor associated with lack of bystander CPR (Odds ratio=1.54 against passers-by, 2.09 against friends and colleagues, and 5.15 against others) . In all subcategories, the incidences of shockable initial rhythms and outcomes were lowest in the OHCAs witnessed by family members. Multiple logistic regression disclosed that that family member as a bystander group is one of the independent factor associated with 1-M unfavorable neurological outcomes in all subcategories of bystander-witnessed OHCAs. Conclusions: Family members do not quickly respond to OHCAs and unwilling to perform CPR on their own initiative. OHCAs witnessed by family and having bystander CPR have low incidences of shockable initial rhythm and 1-M favourable neurolofical survival. The first responder system that enable a good BLS performer to quickly reach the scene may be necessary in OHCAs witnessed by family.