Median Yield Research Articles

The contemporary status of robotic intracorporeal neobladder

Robotic intracorporeal neobladder (RIN) is increasingly the modality of choice for intracorporeal urinary diversion in high-volume Robotic Urology centers. This article details the modern technique of RIN, explains specific tips and tricks to facilitate timely operative progression as well as weighs the outcomes from recently published series. An OVID/EMBASE database search was done using keywords: robotic, cystectomy, intracorporeal neobladder, orthotopic, and intracorporeal urinary diversion. The inclusion criteria were original studies on Robot-Assisted Radical Cystectomy (RARC) with RIN series, available in full text in English, published over the last ten years with a specific analysis of oncological and functional outcomes. Pooled data analysis of the 10 studies included shows 80% of patients had organ-confined disease (≤pT2), 1.86% of patients had positive surgical margin, median lymph node yield of 23 nodes (IQR = 7.5), and cancer-specific survival rate of 78% (range 72%-100%) over a mean follow up of 27.43 months (range 13-37 months). Functionally, the median day continence rate is 81.5%, night continence rate is 61%, and rate of return to spontaneous sexual activity is 33.5%. This compares favorably with outcomes of The International Robotic Cystectomy Consortium - Extracorporeal Urinary Diversion data and data from open radical cystectomy (ORC) neobladder series with long term follow up. High-volume robotic centers have successfully introduced programs for RARC, with RIN demonstrating its safety and feasibility. Their results suggest potential to improve perioperative and functional outcomes over ORC. Moreover, under mentorship, surgeons can learn the technique of RARC and RIN without these outcomes being significantly affected.

Occurrence of symptomatic lymphocele after open and robot-assisted radical prostatectomy.

IntroductionThe aim of this article was to evaluate the prevalence and predictors of symptomatic lymphocele after open retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP).Material and methodsA total of 472 patients undergoing RRP (n = 241) or RARP (n = 231) were retrospectively analyzed with a 2-year follow-up for age, body mass index (BMI), total serum prostate-specific antigen (PSA), lymphocele formation and histopathological features. Univariate and multivariate logistic regression models were used to identify independent predictors of symptomatic lymphocele.ResultsPatients undergoing RRP developed significantly less overall lymphoceles than after RARP (8.2% vs 16.7%; p = 0.049), but no difference was determined for symptomatic events requiring intervention (7.4% vs 11.7%, p = 0.315). Although more pelvic lymph node dissections (PLND) were performed during RARP (70.1% vs 50.6%; p <0.001), significantly more cases with lymphatic invasion were observed after RRP (18% vs 6.2%, p = 0.002). The median lymph node yield during RRP and RARP were 11 and 10, respectively (p = 0.381). In multivariate logistic regression, we identified the number of dissected lymph nodes (n = 11) (OR 1.1; 95% Cl 1.055 - 1.147; p = 0.001), the Gleason score ≥ 8 (OR 4.7; 95% Cl 2.365 – 9.363; p = 0.001) and the total PSA ≥10 ng/ml (OR 1.05; 95% Cl 1.02 – 1.074; p = 0.001) as independent predictors for the development of symptomatic lymphocele.ConclusionsNext to an extended lymph node yield, high-grade disease was associated with a higher risk to develop symptomatic lymphocele irrespective of the technical approach. The identification of risk factors might prove valuable in clinical practice when assessing and counselling patients considering surgical treatment of prostate cancer.

Presence of perineural invasion determines the need for adjuvant chemotherapy in resected pancreatic carcinoma with node negative disease following neoadjuvant therapy; a multi-institutional analysis

Presenter: Abdulrahman Hammad MBBCh | University of Pittsburgh Medical Center Background: There is growing interest in the potential benefit of neoadjuvant therapy (NAT) for patients with operable pancreatic cancer. NAT is infrequently associated with a complete histologic response in the primary tumor but does result in a robust response in local-regional lymph nodes. Such downstaging of node positive disease to node negative after NAT may have implications for the use of additional postoperative adjuvant therapy (AT). We sought to examine the prognostic implications of AT in node negative patients following NAT and surgery and identify predictors of overall survival (OS). Methods: Patients treated at two high-volume centers who underwent surgical resection following NAT between 2010-2018 and had lymph node negative disease were identified. Kaplan-Meier survival estimates and Cox-proportion hazard regression were performed to identify predictors of OS. Results: Four hundred thirty-one patients were included (mean age 65yrs, 51% females). The predominant NAT was gemcitabine-based (45%) and the median duration of therapy was two months (Interquartile range (IQR): 2, 3). Neoadjuvant chemoradiation (NART) was administered to 65% of the cohort. Pancreatoduodenectomy was performed in 72% and 37% required concomitant vascular resection. The median lymph node yield was 26 (IQR: 19, 34) and 254 (59%), 92 (21%) & 87 (20%) of the cohort had perineural invasion (PNI), lymphovascular invasion (LVI) and residual positive margins (R1) respectively. The median follow-up time was 45.9 months (IQR: 40.7, 54.8). On adjusted analysis, poorly differentiated tumors [HR:1.86 (95%CI: 1.14-3.05), p = 0.013], LVI [HR: 1.45 (95%CI: 1.04-2.01), p = 0.027], and vascular resection [HR: 1.38 (95%CI: 1.06-1.80), p = 0.018] were all independent predictors of survival. PNI was associated with worse survival [HR: 1.72 (95%CI: 1.18, 2.51), p = 0.005] while NART trended towards an association with better survival although did not reach statistical significance [HR: 0.66 (95%CI: 0.42, 1.03, p = 0.065]. Although AT is associated with prolonged survival in the overall cohort [HR: 0.47 (95%CI: 0.26, 0.85), p = 0.013] NART weakens the association [ATxNART interaction; HR: 2.50 (1.40, 4.49), p = 0.002] while PNI strengthens the association [ATxPNI interaction; HR: 0.56 (0.32, 0.97), p = 0.038]. Conclusion: In patients with node negative disease following NAT, PNI (as assessed in the final resection specimen), was associated with worse survival, especially when NART was not administered. Although – in this select cohort – survival is associated with tumor grade, LVI, PNI, NART, and vascular resection, the current analysis suggests that the presence of PNI may identify a high-risk subset within the group of N0 patients for whom AT may be of benefit.

The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study.

IntroductionLaparoscopic lateral lymph node dissection (LLND) is an important treatment for patients with lateral lymph node metastasis.AimTo assess the technical feasibility and investigate the surgical outcomes after LLND using the fascia space priority approach for patients with advanced middle and low rectal cancer.Material and methodsConsecutive patients undergoing laparoscopic LLND using the fascia space priority approach from June 2017 to June 2020 were identified from 12 medical centres in mainland China. Three anatomic fascia spaces were dissected to establish the boundaries of the LLND, and the obturator and internal iliac lymph nodes were excised in an en bloc manner. Retrospective clinical data including patient characteristics, surgical details, and pathology were analysed.ResultsA total of 112 patients were identified. All surgeries were completed laparoscopically with no conversions. The mean operation time was 343.6 ±103.8 min for the entire procedure. The median blood loss was 100 ml (range: 100–700 ml). The median lymph node yield was 6 (range: 1–41), and lymph nodes were positive in 39.3% (44/112) of the patients. Sixteen (14.3%) patients had Clavien-Dindo I–II complications, no Clavien-Dindo III–IV complications were identified. The incidence of complications between the bilateral dissection group and the unilateral dissection group was not statistically different (p = 0.19). The complication rate between the “nCRT” group and the “no nCRT” group was not significantly different (p = 0.62) either. There were no perioperative deaths.ConclusionsLaparoscopic LLND using the fascia space priority approach is feasible and safe for patients with lateral lymph node metastasis.

Perioperative Outcome of Systematic Mesopancreas Dissection for Pancreatic and Periampullary Carcinoma at a Tertiary Referral Centre from a Low-middle Income Country

Purpose: Margin negative resection is considered as the surrogate marker of quality surgery. However, in pancreatic cancer the incidence of R1 resection is high despite of a very good quality surgery. Total mesopancreas excision has been considered to improve the margin negative resection and the lymph node yield. Amongst various techniques of mesopancreas excision (SMD), systematic mesopancreas dissection is applicable to pancreatic as well as other periampullary carcinoma. Objective: This study has been done to compare the perioperative outcomes, the lymph node yield and the margin status in patients who undergo standard pancreaticoduodenectomy (ST-PD) and SMD pancreaticoduodenectomy (SMD-PD) for pancreatic and periampullary carcinoma. Methods: A retrospective comparative study was conducted in patients who underwent pancreaticoduodenectomy for pancreatic and periampullary carcinoma in a single unit of Gastrointestinal and Hepatopancreatobiliary surgery at Tribhuvan University Teaching Hospital, Nepal. The demographics, indication of surgery, duration of surgery, intraoperative blood loss, incidence of procedure-specific complications as defined by International study group on pancreatic surgery (ISGPS), length of hospital stay, perioperative mortality, stage of the disease, lymph node yield and margin status were compared between the SMD-PD and ST-PD. Results: Total of 33 patients underwent SMD-PD with the mean age of 56.7 ± 12.9 years with 63.6% of patients being male. The most common indication of surgery was ampullary carcinoma. The demographic data was comparable with the historical data of 45 patients who underwent ST-PD. The duration of surgery (344.2±48.6 mins vs 374.2 ± 54.9 mins) and intraoperative blood loss (436.4 ± 171.3 ml vs 481.8 ± 196.4 ml) was found to be comparable with the patients who underwent SMD-PD. However, the incidence of postoperative pancreatic fistula and perioperative mortality were less in patients who underwent SMD-PD as compared to the patients who underwent ST-PD (21.2% vs 26.7% and 9.1% vs 11.1% respectively). The rate of margin negative resection was high (97% vs 91.1%). The median lymph node yield was significantly high in patients who underwent SMD-PD (15 vs 6, p < 0.05). Conclusion: SMD-PD is feasible and should be done not only for pancreatic carcinoma but also for other periampullary carcinoma.

Robotic versus laparoscopic distal pancreatectomy for upfront resectable pancreatic cancer: An international retrospective cohort study

Purpose Upfront resectable pancreatic cancer in the left pancreas is increasingly resected through the minimally invasive approach. Robotic distal pancreatectomy (RDP) is an upcoming alternative for laparoscopic distal pancreatectomy (LDP). Yet, the oncological efficacy of RDP is uncertain. The aim of this study is to compare the oncological and surgical outcomes between RDP and LDP. Methods An international retrospective cohort study in consecutive patients treated with RDP or LDP in upfront resectable pancreatic cancer in 34 high-volume (>50 MIDP total experience) centers from 11 countries (2010-2019). The primary outcomes were R0 resection and lymph node yield. Kaplan-Meier estimates were used for survival rates. Results Overall, 542 patients were included, 103 (19%) underwent RDP and 439 (81%) LDP. Preoperative characteristics were similar. RDP was associated with a higher median lymph-node yield (18 vs 16, P=0.021) and a comparable R0-resection rate (76% vs 69%, P=0.40). RDP was associated with a longer operative time (290 min vs 240 min, P<0.001) and less conversions (5% vs 17%, P=0.001) without emergency conversions (i.e. for bleeding), compared to 29% for LDP. A higher rate of major morbidity (Clavien-Dindo ≥3) (26% vs 16%, P=0.017) was observed after RDP, but 30-day mortality (2% vs 1%, P=0.24) and in-hospital mortality (2% vs 0.4%, P=0.26) did not differ significantly. Median length of stay was longer following RDP (10 vs 8 days, P=0.001). The 3-year survival rate [34% vs 38%, P=0.73] and median overall survival [28 months (95% CI, 9-47) vs 31 months (95% CI, 25-37), P=0.73] did not differ significantly. Conclusion For upfront resectable pancreatic cancer, RDP was associated with a similar R0 resection rate, but a higher lymph node yield compared to LDP. Given the contradicting outcomes in conversion rate, morbidity rate, operative time, and hospital stay, randomized trials are required in centers that have surpassed the learning curve.

Prediction of Sediment Yield in the Middle Reaches of the Yellow River Basin Under Extreme Precipitation

The Yellow River is one of the rivers with the largest amount of sediment in the world. The amount of incoming sediment has an important impact on water resources management, sediment regulation schemes, and the construction of water conservancy projects. The Loess Plateau is the main source of sediment in the Yellow River Basin. Floods caused by extreme precipitation are the primary driving forces of soil erosion in the Loess Plateau. In this study, we constructed the extreme precipitation scenarios based on historical extreme precipitation records in the main sediment-yielding area in the middle reaches of the Yellow River. The amount of sediment yield under current land surface conditions was estimated according to the relationship between extreme precipitation and sediment yield observations in the historical period. The results showed that the extreme rainfall scenario of the study area reaches to 159.9 mm, corresponding to a recurrence period of 460 years. The corresponding annual sediment yield under the current land surface condition was range from 0.821 billion tons to 1.899 billion tons, and the median annual sediment yield is 1.355 billion tons, of which more than 91.9% of sediment yields come from the Hekouzhen to Longmen sectionand the Jinghe River basin. Therefore, even though the vegetation of the Loess Plateau has been greatly improved, and a large number of terraces and check dams have been built, the flood control and key project operation of the Yellow River still need to be prepared to deal with the large amount of sediment transport.

PATH-27. MUTATION DETECTION USING PLASMA CELL-FREE DNA IN CHILDREN WITH CENTRAL NERVOUS SYSTEM TUMORS

BACKGROUNDThe role of plasma cell-free DNA (cfDNA) as a cancer biomarker for tracking treatment response and detecting early relapse has been well described for solid tumors outside the central nervous system (CNS). However, the presence of a blood-brain barrier complicates the application of plasma cfDNA analysis for patients with CNS malignancies.METHODScfDNA was extracted from plasma of pediatric patients with CNS tumors utilizing a QIAmp® MinElute® kit and quantitated with Qubit 2.0 Fluorometer. Extensive genomic testing, including targeted DNA and RNA solid tumor panels, exome and transcriptome sequencing, as well as copy number array, was performed on matched tumor samples as part of the Texas KidsCanSeq study. An Archer® Reveal ctDNA28 NGS kit was then used for assaying the sensitivity of detecting tumor-specific mutations in the plasma of these patients.RESULTSA median of 10.7ng cfDNA/mL plasma (Interquartile range: 6.4 – 15.3) was extracted from 78 patients at time of study enrollment. Longitudinal samples from 24 patients exhibited a median yield of 7.7ng cfDNA/mL plasma (IQR: 5.9 – 9.1). An initial cohort of 6 patients was identified with 7 somatic variants covered by the Archer® Reveal kit. Four of seven mutations identified in matched tumor specimens were detected in patient plasma at variant allele frequencies ranging from 0.2–1%.CONCLUSIONSWhile challenging, detection of cfDNA in the plasma of pediatric patients with CNS tumors is possible and is being explored in a larger patient cohort along with pilot studies investigating cerebrospinal fluid as an additional source for tumor-specific cfDNA.

Assessment of sowing dates and plant densities using CSM-CROPGRO-Soybean for soybean maturity groups in low latitude

AbstractCrop models can be used to explain yield variations associated with management practices, environment and genotype. This study aimed to assess the effect of plant densities using CSM-CROPGRO-Soybean for low latitudes. The crop model was calibrated and evaluated using data from field experiments, including plant densities (10, 20, 30 and 40 plants per m2), maturity groups (MG 7.7 and 8.8) and sowing dates (calibration: 06 Jan., 19 Jan., 16 Feb. 2018; and evaluation: 19 Jan. 2019). The model simulated phenology with a bias lower than 2 days for calibration and 7 days for evaluation. Relative root mean square error for the maximum leaf area index varied from 12.2 to 31.3%; while that for grain yield varied between 3 and 32%. The calibrated model was used to simulate different management scenarios across six sites located in the low latitude, considering 33 growing seasons. Simulations showed a higher yield for 40 pl per m2, as expected, but with greater yield gain increments occurring at low plant density going from 10 to 20 pl per m2. In Santarém, Brazil, MG 8.8 sown on 21 Feb. had a median yield of 2658, 3197, 3442 and 3583 kg/ha, respectively, for 10, 20, 30 and 40 pl per m2, resulting in a relative increase of 20, 8 and 4% for each additional 10 pl per m2. Overall, the crop model had adequate performance, indicating a minimum recommended plant density of 20 pl per m2, while sowing dates and maturity groups showed different yield level and pattern across sites in function of the local climate.

Robotic Nephroureterectomy vs Laparoscopic Nephroureterectomy: Increased Utilization, Rates of Lymphadenectomy, Decreased Morbidity Robotically

Introduction and Objective: Robotic radical nephroureterectomy (RRNU) may offer advantages over laparoscopic radical nephroureterectomy (LRNU). The purpose of this study is to evaluate the overall survival (OS) of patients with upper tract urothelial carcinoma (UTUC) who underwent RRNU vs LRNU and identify factors that account for differences. Methods: The National Cancer Database was queried from 2010 to 2016 for patients with American Joint Committee on Cancer 6th/7th edition Stage I/II/III UTUC. Kaplan-Meier analysis compared LRNU and RRNU OS. Univariate analysis detected differences between the groups. Cox regression determined factors associated with mortality rate. Logistic regression identified predictors of a lymph node dissection (LND) and 90-day mortality rate. Results: A total of 2631 patients met the criteria, 1129 of whom underwent RRNU and 1502 LRNU, with a follow-up of 33 and 35 months, respectively (p = 0.063). RRNU had a median OS of 71.1 vs 62.6 months (p = 0.033). LRNU patients were older (72.7 vs 71.4, p < 0.001) and had no differences in comorbidities, pathologic T stage, or grade. The LRNU cohort was less likely to undergo LND (19% vs 35%, p < 0.001) and had a lower median lymph node yield (3 vs 4, p < 0.001). LRNU patients more likely underwent conversion to an open procedure, had longer hospital stays, and higher 30- and 90-day mortality rates. LRNU was independently associated with mortality rate (p = 0.030). Age, grade, positive margins, pT/pN stage were associated with mortality rate. Younger age, RRNU, surgery at an academic center, and neoadjuvant chemotherapy predicted an LND. Conclusions: RRNU demonstrated increased rates of LND and may offer a short-term morbidity benefit to LRNU. Survival differences may be due to improved characterization of disease through LND.

Salvage treatment with plerixafor in poor mobilizing allogeneic stem cell donors: results of a prospective phase II-trial

We conducted a prospective clinical trial to investigate the safety and efficacy of plerixafor (P) in allogeneic peripheral blood stem cells (PBSC) donors with poor mobilization response to standard-dose granulocyte colony-stimulating factor (G-CSF), defined by <2 × 106 CD34 + cells/kg recipient body-weight (CD34+/kg RBW) after 1st apheresis. A single dose of 240 µg/kg P was injected subcutaneously at 10 p.m. on the day of the 1st apheresis. Thirty-seven allogeneic PBSC donors underwent study treatment. The median CD34+ count in peripheral blood was 15/µl on Day 1 after G-CSF alone, versus 44/µl on Day 2 after G-CSF plus P (p < 0.001). The median yield of CD34+ cells was 1.1 × 108 on Day 1 and 2.8 × 108 on Day 2. In contrast to a median yield of only 1.31 × 106 CD CD34+/kg RBW on Day 1, triggering study inclusion, a median of 3.74 × 106 CD CD34+/kg RBW were collected with G-CSF plus P on Day 2. Of 37 donors, 21 reached the target cell count of >4.5 × 106 CD34+/kg RBW (57%, 95%CI 40–73%). No donor experienced a severe adverse event requiring treatment. In conclusion, P might be considered on a case-by-case basis for healthy allogeneic donors with very poor stem cell mobilization success after G-CSF.

Intensification options of small holders’ cassava production in South‐west Nigeria

AbstractCassava (Manihot esculenta Crantz) is a staple food crop in Nigeria, but root yields hardly exceed 10 t ha−1. Intensification of small holders’ cassava production is key to improved food security and income generation. We tested, in two demonstration trials and 20 on‐farm trials, different intensification options: cassava growth type (erect and branching), fertilizer application (with and without), and cassava − legume arrangement (0.5 by 2 m/1 by 1 m spacing of cassava) in demonstration trials. In on‐farm trials, farmers tested a subset of these treatments. The demonstration trials had median cassava yields of about 20 (Akindele village) and 15 (Osunwoyin village) t ha−1. Fertilizer application increased the yield of the erect cassava variety. Cassava intercropped with cowpea [Vigna unguiculata (L.) Walp.], reduced yield and the branching cassava variety produced lower yield than the erect variety. Median cowpea yields were about 1 and 1.5 t ha−1 pod yield. Median yields in the on‐farm trials were about 10 t ha−1. Intercropping with cowpea reduced cassava root yields (on average by 2.4 t ha−1), again, cowpea pod yields of 1−1.5 t ha−1 were attainable. In summary, this study confirmed that intensification measures need to be site and user or farmer specific.

Endocrine Requirements for Oocyte Maturation Following hCG, GnRH Agonist, and Kisspeptin During IVF Treatment.

ObjectiveThe maturation of oocytes to acquire competence for fertilization is critical to the success of in vitro fertilization (IVF) treatment. It requires LH-like exposure, provided by either human chorionic gonadotropin (hCG), or gonadotropin releasing hormone agonist (GnRHa). More recently, the hypothalamic stimulator, kisspeptin, was used to mature oocytes. Herein, we examine the relationship between the endocrine changes following these agents and oocyte maturation.DesignRetrospective cohort study.MethodsProspectively collected hormonal data from 499 research IVF cycles triggered with either hCG, GnRHa, or kisspeptin were evaluated.ResultsHCG-levels (121 iU/L) peaked at 24 h following hCG, whereas LH-levels peaked at ~4 h following GnRHa (140 iU/L), or kisspeptin (41 iU/L). HCG-levels were negatively associated with body-weight, whereas LH rises following GnRHa and kisspeptin were positively predicted by pre-trigger LH values. The odds of achieving the median mature oocyte yield for each trigger were increased by hCG/LH level. Progesterone rise during oocyte maturation occurred precipitously following each trigger and strongly predicted the number of mature oocytes retrieved. Progesterone rise was positively associated with the hCG-level following hCG trigger, but negatively with LH rise following all three triggers. The rise in progesterone per mature oocyte at 12 h was greater following GnRHa than following hCG or kisspeptin triggers.ConclusionThe endocrine response during oocyte maturation significantly differed by each trigger. Counter-intuitively, progesterone rise during oocyte maturation was negatively associated with LH rise, even when accounting for the number of mature oocytes retrieved. These data expand our understanding of the endocrine changes during oocyte maturation and inform the design of future precision-triggering protocols.

Modelling parameter uncertainty reveals bushmeat yields versus survival trade-offs in heavily-hunted duiker Cephalophus spp.

Reliably predicting sustainable exploitation levels for many tropical species subject to hunting remains a difficult task, largely because of the inherent uncertainty associated with estimating parameters related to both population dynamics and hunting pressure. Here, we investigate a modelling approach to support decisions in bushmeat management which explicitly considers parameter uncertainty. We apply the approach to duiker Cephalophus spp., assuming either a constant quota-based, or a constant proportional harvesting, strategy. Within each strategy, we evaluate different hunting levels in terms of both average yield and survival probability, over different time horizons. Under quota-based harvesting, considering uncertainty revealed a trade-off between yield and extinction probability that was not evident when ignoring uncertainty. The highest yield was returned by a quota that implied a 40% extinction risk, whereas limiting extinction risk to 10% reduced yield by 50%-70%. By contrast, under proportional harvesting, there was no trade-off between yield and extinction probability. The maximum proportion returned a yield comparable with the maximum possible under quota-based harvesting, but with extinction risk below 10%. However, proportional harvesting can be harder to implement in practice because it depends on an estimate of population size. In both harvesting approaches, predicted yields were highly right-skewed with median yields differing from mean yields, implying that decision outcomes depend on attitude to risk. The analysis shows how an explicit consideration of all available information, including uncertainty, can, as part of a wider process involving multiple stakeholders, help inform harvesting policies.

294 LONG TERM OUTCOMES OF THORACOSCOPIC-ASSISTED OESOPHAGECTOMY FOR EARLY OESOPHAGEAL CANCER

Abstract Oesophageal cancer is the 9th most common cancer in Scotland, yet is ranked 5th for cancer mortality. This is in part due to most new patients presenting with locally-advanced or metastatic disease. Early disease is often found during Barrett's surveillance or serendipitously. There is a paucity of literature describing the outcomes of patients who undergo resection for early disease in Europe, particularly morbidity, actual five-year survival rate, recurrence patterns and ultimate causes of death. Methods Data for fifty consecutive patients from the Royal Infirmary Edinburgh (RIE) with cN0 disease who underwent thoracoscopically-assisted McKeown (three-stage) oesophagectomy between 2005 and 2013 were recorded in a prospectively-maintained database. 20/50 were in a formal endoscopic surveillance program for Barrett’s oesophagus. Endoscopic ultrasound (EUS) became widely used at RIE in 2007 with the introduction of an endoscopic mucosal resection service, with 39/40 patients operated on since 2007 undergoing pre-operative EUS. Results Median age was 67 (range 46–81) with 34 males and 16 females. 44 had ≤pT1b, while 48 patients were pN0 (median node yield of 12). There were 4 anastomotic leaks, 4 recurrent laryngeal nerve palsies and 2 tracheo-oesophageal fistulas. There was one in-hospital death secondary to intra-operative and post-operative myocardial infarctions. As of January 2020, 16/50 patients had died, with a median survival of 9 years; five year survival was approximately 85%. 5 patients died of metastatic disease (1.3 to 6.8 years post-resection). 10 patients died of other causes, the most common being alcoholic liver disease (n = 3). Conclusion Patients in this case series received high quality surgery and peri-operative care, and survival rates were high. This dataset demonstrates that a holistic approach to healthcare is vitally important in the long-term care of such a cohort, because most deaths were not related to their cancer. This should be kept in mind when counselling patients with early disease and when liaising with their primary care provider.

Mesopancreas level 3 dissection in robotic pancreaticoduodenectomy

BackgroundThere are no reports of performing mesopancreas dissections in robotic pancreaticoduodenectomy. This study evaluated the feasibility and justification for mesopancreas level 3 dissection in robotic pancreaticoduodenectomy. MethodsSurgical outcomes after robotic pancreaticoduodenectomy and open pancreaticoduodenectomy were evaluated and compared. ResultsThere were 289 robotic pancreaticoduodenectomy and 162 open pancreaticoduodenectomy patients included in the study. Postoperative diarrhea occurred in 34.5% of mesopancreas level 3 dissection cases and was higher than in levels 2 and 1 dissection cases, P < .001. Blood loss in the robotic pancreaticoduodenectomy group was higher for mesopancreas level 3 dissection, with a median loss of 263 mL (P = .015). The rate of R0 resection with margin >1 mm was higher for mesopancreas level 3 dissection (93.8%) than for level 2 dissection (72.2%) (P < .001). The lymph node yield was higher for mesopancreas level 3 dissection in robotic pancreaticoduodenectomy; the median lymph node yield was 21 for level 3, 18 for level 2, and 14 for level 1 (P < .001). Compared with mesopancreas levels 1 and 2 dissections in the robotic pancreaticoduodenectomy groups, level 3 dissection did not show increased surgical mortality or postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, chyle leakage, bile leakage, or wound infection. Compared with open pancreaticoduodenectomy, mesopancreas level 3 dissection in robotic pancreaticoduodenectomy had less blood loss, no delayed gastric emptying, and lower chyle leakage. ConclusionMesopancreas level 3 dissection in robotic pancreaticoduodenectomy is feasible without compromising surgical safety. Therefore, robotic pancreaticoduodenectomy can be recommended as a safe alternative to open pancreaticoduodenectomy for mesopancreas level 3 dissection.

Bortezomib and cyclophosphamide based chemo-mobilization in multiple myeloma.

Hematopoietic stem and progenitor cell (HSPC) mobilization regimens in multiple myeloma typically use filgrastim (GCSF) alone or combination of GCSF with plerixafor or high-dose cyclophosphamide. Murine model and human studies have shown HSPC mobilization potential of bortezomib. A total of 37 patients underwent mobilization using bortezomib 1.3mg/m2 on day 1, 4, 8 and 11, cyclophosphamide 1g/m2 on day 8 and 9, and GCSF 10μg/kg from day 10 (B-Cy-GCSF). This regimen was compared with our earlier cohort of patients where cyclophosphamide was given at dose of 1g/m2 on day 1 and day 2 followed by GCSF 10μg/kg from day 4 (Cy-GCSF). In B-Cy-GCSF group, median CD34 cells collected were 9.21 × 106/kg (range 4.95-17.1) while inthe Cy-GCSF cohort, the median CD34 cell yield was 8.2 × 106/kg (0.4-24.2). Target CD34 cells yield of 5 × 106/kg was achieved with single apheresis in 58.6% of patients after B-Cy-GCSF mobilization as compared to 44.3% in Cy-GCSF group (p = 0.07). Three patients failed mobilization after Cy-GCSF, while no patients failed mobilization in bortezomib group. Addition of bortezomib to Cy-GCSF mobilization showed a trend towards increased CD34 collection and reduced need for apheresis sessions.

English

This paper analyses the effect of labor opportunity cost on economic profitability of fertilizer microdosing (FM) in Burkina Faso. In order to assess the incremental change in net income when the investment cost increases and takes into account labor opportunity cost, the marginal value cost ratio (MVCR) approach is used. Using data from farmer&rsquo;s field, the results showed that for both crops, the median yield of the fertilizer microdosing plots is 500 kg.ha-1, which is slightly higher than yield from recommended dose plots. Moreover, the rate of fertilizer microdosing plots of millet with a marginal value cost ratio above 2 shifts from 50% (without labor opportunity cost) to 41% (with labor opportunity cost) and not even one recommended dose plots reached this threshold. These findings argued that fertilizer microdosing adopters remain economically profitable for farmers compared to traditional practices despite the opportunity cost of labor. However, because of its importance in the process of fertilizer microdosing adoption, labor costs must be included in its economic evaluation. The results of this study confirm the need to accelerate mechanization of fertilizer microdosing application. Key words: Fertilizer microdosing (FM), labor, marginal value cost ratio, Burkina Faso. &nbsp

Abstract 3518: Pilot study of prostate cancer survival among African patients in the Men of African Descent and Cancer of the Prostate (MADCaP) Consortium

Abstract Introduction: Men of African descent have the highest burden of aggressive and lethal prostate cancer (PrCa). In Sub-Saharan Africa (SSA), PrCa accounts for 19% of all cancer-related deaths. However, there has been no large-scale PrCa survival studies in SSA. The objective of this study was to assess the feasibility of establishing a PrCa survival cohort in SSA, ascertain vital status and cause of death, determine willingness of PrCa patients to participate and evaluate feasibility of collecting tumor tissues and extract RNA. Methods: A total of 137 PrCa patients, who were initially enrolled in an ongoing PrCa genetic study across seven hospitals in West and South Africa (U01CA184374) in the MADCaP consortium, were followed from their cancer diagnosis and enrollment into the main study through date of death, date of last contact or end of follow-up: 12/31/2018. Follow-up was carried out by direct phone contact of patients and/or their next-of-kin and by reviewing medical records of follow-up hospital visits. PrCa patients alive at contact were invited to participate into the pilot study and completed a brief survey to assess their general health and symptoms as well as quality of life. Formalin-fixed, paraffin-embedded (FFPE) PrCa tissues from 20 patients were retrieved from pathology departments of four hospitals in West Africa. RNA extraction from tumor tissues was carried out using the Qiagen RNeasy® FFPE Kit in the Molecular Cytogenetic Core at Einstein (USA). Results: The average age of 137 PrCa patients was 68 years old (range 40-88), 70 (51%) and 41 (30%) of them were diagnosed with a Gleason score 8-10 cancer, or advanced tumor stage (T3/T4), and the median PSA at diagnosis was 100 ng/ml. Majority of patients received either radiation or hormone deprivation therapy; although there was variability across centers. During an average 20.3 months of follow-up, a total of 29 (21%) patients had died, and 23 (17%) were lost to follow-up; 69% of deaths were due to PrCa. Interestingly the majority of patients who died (62%) and those lost to follow-up (61%) had Gleason score 8-10 cancer. Among PrCa patients alive (N=85) at contact, 95% agreed to participate in the pilot study and completed the protocol. The median RNA yield of tumor samples was 645 ng (range 280-1,820 ng). Conclusions: This feasibility study demonstrated the ability to follow-up PrCa patients across several hospitals in West and South Africa and highlighted the advanced clinical characteristics of PrCa and relatively low survival among African men in SSA. Tumor samples also yielded sufficient RNA that can be used for molecular studies. Larger studies are needed to better understand the clinical and epidemiological risk factors for PrCa survival in SSA and to develop strategies to address survival bias and lost to follow-up. Studies of PrCa survival in Africa might also contribute to better understanding of PrCa racial disparities in the USA. Citation Format: Ilir Agalliu, Caroline Andrews, Akindele Olupelumi Adebiyi, Mohamed Jalloh, Maureen Joffe, Timothy R. Rebbeck, Ann Hsing. Pilot study of prostate cancer survival among African patients in the Men of African Descent and Cancer of the Prostate (MADCaP) Consortium [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3518.

Robotic complete mesocolic excision and central vascular ligation for right-sided colon cancer: short-term outcomes from a case series.

Despite conflicting data regarding oncological outcomes, studies demonstrate that complete mesocolic excision (CME) and central vascular ligation (CVL) for right-sided colon cancer removes significantly more tissue and yields higher lymph node counts when compared to conventional resection. This study aims to report the safety profile of CME and CVL in patients undergoing robotic surgery for right-sided colon cancer during the introduction of this technique across two institutions. Patients who underwent an elective robotic right colectomy with CME and CVL for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and April 2020 were included. Demographic, clinical, perioperative and histopathological variables were recorded and analysed. Twenty patients (13 females) with a median age of 69 (23-83) years and median body mass index of 27 (19-46) were included. All of them had a pre-operative diagnosis of right-sided colon adenocarcinoma. Median operative time and blood loss were 140 (130-300) min and 30 (20-100) mL, respectively. There were no conversions or intra-operative complications. There were two post-operative complications recorded (one ileus and one intra-abdominal collection treated with intravenous antibiotics) and no re-interventions. Median length of stay was 4 (2-8) days. All patients had an R0 resection, and the median lymph node yield was 36 (22-80) lymph nodes. This series demonstrates a safe introduction of robotic CME and CVL in patients with right-sided colon cancer. The lymph node harvest obtained with CME and CVL in this setting was high.