Multi-institutional Experience Research Articles

Routine Collection of Long-Term Patient-Centered Outcomes after Trauma: A Multi-Institutional Experience

Routine Collection of Long-Term Patient-Centered Outcomes after Trauma: A Multi-Institutional Experience

Endovascular treatment for acute basilar thrombosis via a transradial approach: Initial experience and future considerations.

Acute basilar artery occlusion (BAO) secondary to emergent large vessel occlusion (ELVO) has an extremely poor natural history, with a reported mortality rate up to 95%. Mechanical thrombectomy in the setting of ELVO is generally performed via a transfemoral approach. However, radial access is increasingly being utilized as an alternative. We report our initial multi-institutional experience using primary radial access in the treatment of acute BAO in nine consecutive cases. Technical success defined as a TICI score of 2B or 3 was achieved in 89% of cases. Average puncture to revascularization time was 35.8 minutes. There were no complications related to radial artery catheterization. We contend radial access should potentially be considered as the first-line approach given inherent advantages over femoral access for mechanical thrombectomy for BAO.

Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: A multi-institutional experience

ObjectiveTo evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). MethodsData of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. ResultsOverall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009–2010 to 97% in the year 2015–2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. ConclusionsThe implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.

Pectus excavatum repair after sternotomy: the Chest Wall International Group experience with substernal Nuss bars.

Patients with pectus excavatum (PE) after prior sternotomy for cardiac surgery present unique challenges for repair of PE. Open repairs have been recommended because of concerns about sternal adhesions and cardiac injury. We report a multi-institutional experience with repair utilizing substernal Nuss bars in this patient population. Surgeons from the Chest Wall International Group were queried for experience and retrospective data on PE repair using sub-sternal Nuss bars in patients with a history of median sternotomy for cardiac surgery (November 2000 to August 2015). A descriptive analysis was performed. Data for 75 patients were available from 14 centres. The median age at PE repair was 9.5 years (interquartile range 10.9), and the median Haller index was 3.9 (interquartile range 1.43); 56% of the patients were men. The median time to PE repair was 6.4 years (interquartile range 7.886) after prior cardiac surgery. Twelve patients (16%) required resternotomy before support bar placement: 7 pre-emptively and 5 emergently. Sternal elevation before bar placement was used in 34 patients (45%) and thoracoscopy in 67 patients (89%). Standby with cardiopulmonary bypass was available at 9 centres (64%). Inadvertent cardiac injury occurred in 5 cases (7%) without mortality. Over a broad range of institutions, substernal Nuss bars were used in PE repair for patients with a history of sternotomy for cardiac surgery. Several technique modifications were reported and may have facilitated repair. Cardiac injury occurred in 7% of cases, and appropriate resources should be available in the event of complications. Prophylactic resternotomy was reported at a minority of centres.

Time to Initiation of Adjuvant Chemotherapy in Pancreas Cancer: A Multi-Institutional Experience.

Despite randomized trials addressing adjuvant therapy (AT) for pancreas cancer, the ideal time to initiate therapy remains undefined. Retrospective analyses of the ESPAC-3 trial demonstrated that time to initiation of AT did not impact overall survival (OS). Given the absence of confirmatory data outside of a clinical trial, we sought to determine if AT timing in routine clinical practice is associated with OS differences. Perioperative data of pancreatectomies for ductal adenocarcinoma from five institutions (2005-2015) were assessed. Delay in AT was defined as initiation >12weeks after surgery. Multivariate analysis was performed to identify predictors of mortality. Of 867 patients, 172 (19.8%) experienced omission of AT. Improved OS was observed in patients who received AT compared with patients who did not (24.8 vs. 19.1months, p<0.01). Information on time to initiation of AT was available in 488 patients, of whom 407 (83.4%) and 81 (16.6%) received chemotherapy≤12 and>12weeks after surgery, respectively. There were no differences in recurrence-free survival or OS (all p>0.05) between the timely and delayed AT groups. After controlling for perioperative characteristics and tumor pathology, patients who initiated AT≤12 or>12weeks after surgery had a 50% lower odds of mortality than patients who only underwent resection (p<0.01). In a multi-institutional experience of resected pancreas cancer, delayed initiation of AT was not associated with poorer survival. Patients who do not receive AT within 12weeks after surgery are still appropriate candidates for multimodal therapy and its associated survival benefit.

Survival and aesthetic outcome of local flaps used for reconstruction of face defects after excision of skin malignancies: Multi-institutional experience of 175 cases

Survival and aesthetic outcome of local flaps used for reconstruction of face defects after excision of skin malignancies: Multi-institutional experience of 175 cases

Multi Institutional Experience with the GreenLight Simulator

Multi Institutional Experience with the GreenLight Simulator

PO-0680: SBRT for locally advanced pancreatic cancer (LAPC): a retrospective multi-institutional experience

PO-0680: SBRT for locally advanced pancreatic cancer (LAPC): a retrospective multi-institutional experience

Iatrogenic biliary injuries: a multi institutional experience

Objective: To review incidence of iatrogenic biliary injuries on three different HPB referral centre. Methods: A total of 14 patients were included in 24 months in this retrospective cohort study. The patients enrolled on this study are from three HPB referral centre. Demographic, surgical findings and surgical reconstruction were analysed. Results: This HPB referral centres are performing 600–800 laparoscopic cholecystectomy per year. Three patients were from San Ignacio Hospital, two patients from Policy Hospital and 9 patients were from Mederi Hospital in 24 months. The median age was 52 years old. The majority of patients were women. Lesions were classified Strasberg E1 (7) 50%, Strasberg E2 (1) 7.14% Strasberg E4 (3) 21.48% Strasberg E5 (1) 7.14% Strasberg D (2) 14.28%. All patients were reconstructed in the first 2 weeks after the iatrogenic lesions with a Roux en Y Hepatojejunostomy. Early medical complications were one patient with acute myocardial infarction. One 85 years-old patient had a PE two weeks after surgery. No stent or drains were used. No fistulas were reported. Conclusion: Biliary iatrogenic injuries still are frequent. Roux en Y hepaticojejunostomy is a safe technique with low rate fistula or any other surgical complications. Drains or stent are not recommended. HPB centre are attending more patients with iatrogenic biliary injuries.

MP08-15 MULTI INSTITUTIONAL STUDY ON MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING/ULTRASOUND FUSION BIOPSY, ARE WE GETTING BETTER?

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2017MP08-15 MULTI INSTITUTIONAL STUDY ON MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING/ULTRASOUND FUSION BIOPSY, ARE WE GETTING BETTER? Wei Phin Tan, Thomas Hwang, Mukund Gande, Daniel Dalton, Paul Yonover, Kalyan Latchamsetty, and Christopher Coogan Wei Phin TanWei Phin Tan More articles by this author , Thomas HwangThomas Hwang More articles by this author , Mukund GandeMukund Gande More articles by this author , Daniel DaltonDaniel Dalton More articles by this author , Paul YonoverPaul Yonover More articles by this author , Kalyan LatchamsettyKalyan Latchamsetty More articles by this author , and Christopher CooganChristopher Coogan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.302AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The usage of multi-parametric Magnetic Resonance Imaging/Ultrasound fusion biopsy (Fbx) to aid in the diagnosis of clinically significant (CS) prostate cancer (CaP) has taken place in recent years. Our objective was to determine if the detection rate of our multi institutional experience with Fbx and standard 12 core sextant biopsy (SBx) in detecting clinically significant prostate cancer is improving over time. METHODS A retrospective review of 803 patients who underwent FBx biopsy and SBx in the same setting between September 2014 and September 2016 was performed. Group 1 consisted of patients who underwent FBx and SBx in the first year of starting FBx and group 2 consisted of patients who underwent FBx and SBx in the second year of starting FBx. All patients underwent a 3-Tesla multi-parametric MRI (mpMRI) performed at 3 different institutions. mpMRI was performed using T1/T2 phases, dynamic contrast enhancement and diffusion weighted imaging. Using a 3-dimensional model fusion software [InVivo (Phillips), Gainesville (USA)], 2-5 fusion biopsies were performed on each prostate lesion. FBx was only performed on patients with at least 1 PIRADS =3 lesion on mpMRI. Gleason score = 7 was considered as clinically significant prostate cancer. RESULTS 341 patients underwent an FBx and SBx between September 2014-2015 and 462 patients underwent FBx and SBx between September 2015-2016. Age, PSA, race, BMI and location where mpMRI was not significantly different between both groups, p>0.05. 109/341 patients (32%) were diagnosed with CaP in 2015 and 162/462 patients (35%) were diagnosed with CaP in group 2. 56/341 patients (16%) were diagnosed with CS CaP in group 1 and 96/462 (21%) patients were diagnosed with CS CaP based off fusion biopsy in group 2 (Table 1). Compared to SBx, FBx is likely to detect clinically CS CaP as can be seen in both years on table 1. CONCLUSIONS Our experience show that FBx may have a learning curve with lower detection rate initially which improves over time. Although FBx is better at detecting CS CaP compared to SBx, more studies are required to determine the ideal number of FBx needed to overcome this initial learning curve and where detection rate would start to plateau. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e97 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Wei Phin Tan More articles by this author Thomas Hwang More articles by this author Mukund Gande More articles by this author Daniel Dalton More articles by this author Paul Yonover More articles by this author Kalyan Latchamsetty More articles by this author Christopher Coogan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD63-12 EXCISION AND PRIMARY ANASTOMOSIS RECONSTRUCTION FOR TRAUMATIC STRICTURES OF THE PENILE URETHRA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2017PD63-12 EXCISION AND PRIMARY ANASTOMOSIS RECONSTRUCTION FOR TRAUMATIC STRICTURES OF THE PENILE URETHRA Boyd Viers, Billy Cordon, Travis Pagliara, Jeremy Scott, Noel Armenakas, and Allen Morey Boyd ViersBoyd Viers More articles by this author , Billy CordonBilly Cordon More articles by this author , Travis PagliaraTravis Pagliara More articles by this author , Jeremy ScottJeremy Scott More articles by this author , Noel ArmenakasNoel Armenakas More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2936AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anastomotic urethroplasty has long been recognized as a reliable method of reconstruction for focal, severe bulbar urethral strictures. The role of excision and primary anastomosis (EPA) is less well defined for penile urethral strictures due to concerns for potential compromise of sexual function. We report a multi-institutional experience with functional outcomes among men undergoing EPA of pendulous urethral strictures. METHODS A retrospective review was conducted of over 2000 urethroplasty patients from two tertiary referral centers from 1995-2016. We identified 13 men treated with EPA for isolated penile urethral strictures, with radiographically confirmed location between the penoscrotal junction and urethral meatus. Clinical characteristics and outcomes are described. Validated questionnaires were utilized to evaluate overall improvement (PGI-I), urinary bother (I-PSS), sexual function (IIEF-5), as well as symptoms related to penile curvature (PDQ). RESULTS Among the 13 men who underwent EPA for penile urethral strictures, strictures were focal (median length 1cm, IQR 1-1.4) and median follow-up was 31 months (IQR 5-110). Only 1/12 (8%) men experienced a treatment failure requiring further instrumentation. None reported new onset penile curvature or curvature related bother (PDQ) following treatment. The majority of men had stricture etiology reported as trauma (10/13, 77%), of which 4 had a history of urethral disruption secondary to penile fracture and 6 iatrogenic trauma. Median patient age was 51 years (IQR 30-60); and 8/12 (67%) had normal preoperative erectile function. After stricture treatment, 75% of men reported a significant global improvement in condition (PGI-I). Sexually active men reported normal erectile function (median IIEF 21 (IQR 19-25), and the majority had only mild urinary bother (median IPSS 4 (IQR 2-14)). The single treatment failure had a history of hypospadias with multiple prior procedures who now requires intermittent catheterization. CONCLUSIONS Among selected patients with focal traumatic strictures involving the penile urethra, EPA appears to be highly effective with negligible impairment of erectile function. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1259 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Boyd Viers More articles by this author Billy Cordon More articles by this author Travis Pagliara More articles by this author Jeremy Scott More articles by this author Noel Armenakas More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High-Impact Educational Practices and the Development of College Students’ Pluralistic Outcomes

The purpose of this study was to explore the relationships between college students’ participation in high-impact educational practices and their self-reported development of leadership skills and multicultural competence. Analyses of data from the multi-institutional Student Experience in the Research University (SERU) survey ( n = 11,997) suggest students who participated in several high-impact educational practices, including common book experiences, service-learning, and courses involving themes related to diversity or global learning had significantly higher perceived development in leadership and multicultural competence. Students who participated in first-year seminars, study abroad, and international programs also reported significantly higher development in multicultural competence while students who participated in learning communities, community service, and internships reported significantly higher leadership skills compared to their peers.

P3.02c-055 Incidence and Grade of Pneumonitis in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients Treated with Anti-PD-1 Antibodies: Topic: IT

Advanced non-small cell lung cancers (NSCLC) can be treated with anti-PD1 (programmed cell death 1) antibodies. Anti-PD-1 therapy can lead to immune mediated adverse events. This study examines the incidence of pneumonitis, a potentially fatal complication, in patients with advanced NSCLC treated with anti-PD-1 antibodies at 3 large hospitals in Sydney, Australia. NSCLC patients commenced on pembrolizumab (2 mg/kg or 10 mg/kg Q3W) or nivolumab (3 mg/kg Q2W) were assessed for adverse events including pneumonitis. Patient demographics, treatment history and immune mediated complications were collected. Pneumonitis was graded according to the Common Terminology Criteria for Adverse Events Version 4.0. Pneumonitis treatment and clinical outcomes were collected. Serial imaging was reviewed with a blinded radiologist. A total of 104 patients between 2012 and 2016 were treated with anti-PD-1 therapy. Median age for included patients was 67. Fourteen (14%), 35 (34%), and 53 (51%) had anti-PD-1 as first, second, or third and subsequent line treatment respectively. Nine patients (9%) developed pneumonitis. Three patients (4%) developed grade 3 (G3) or higher pneumonitis including one patient (1%) that died due to pneumonitis. All patients with ≥G3 pneumonitis required hospital admission with one requiring admission to a high dependency unit. None of the patients with ≥G3 pneumonitis were retreated with anti-PD1 therapy. All patients with ≥G3 pneumonitis died within 5 weeks of their diagnosis of pneumonitis. Seven patients with pneumonitis were treated with steroids. The median length of treatment with steroid was 29 days. Pneumonitis involved both lungs in 3 patients. Of the remaining 6 patients – 2 had all right lung lobes involved, 2 had two lobes and 1 had one lobe. Fifteen (14%) patients had a history of receiving concurrent chemoradiotherapy prior to anti-PD-1 therapy. A further 6 (6%) had curative intent radiotherapy and 15 (14%) had palliative radiotherapy to the thorax prior to anti-PD1 therapy. One of the patient with G3 pneumonitis had previously received radiotherapy to the chest. No association between prior radiotherapy and pneumonitis was seen. The incidence of pneumonitis is rare but our real-life multi-institutional experience demonstrates an incidence higher than reported in the literature. This complication can be life threatening and onset of ≥G3 pneumonitis is associated with short survival.

The Potentially Fatal Ogilvie's Syndrome in Lateral Transpsoas Access Surgery: A Multi-Institutional Experience with 2930 Patients.

Ogilvie's syndrome (OS) is a relatively uncommon pathology characterized by significant colonic dilation in the absence of mechanical obstruction. If unrecognized and untreated, cecal perforation resulting in a mortality rate of 25%-71% may occur. It is a potentially underdiagnosed condition in the lateral transpsoas approach population because of its uncommon nature and imitation of other well-known pathologies. Two thousand nine hundred and thirty patients from 6 separate institutions were retrospectively reviewed since 2007 and screened for OS. All patients underwent a minimum of single-level lateral transpsoas fusion. Diagnostic criteria included signs of a postoperative paralytic ileus combined with abdominal computed tomography showing a cecal diameter greater than 9 cm. Treatment modalities and outcomes were recorded. Eight cases (0.22%) of OS were diagnosed at 6 separate institutions. Most institutions recorded more than 350 lateral access procedures. Four cases were initially diagnosed as a routine postoperative ileus; however, they failed conservative therapy and underwent abdominal CT imaging. Neostigmine treatment was required for 1 patient in the intensive care unit setting, and 3 patients were managed conservatively without complications. Four other patients demonstrated bowel perforation at least 48 hours after surgery and required laparotomy with diversion ileostomy. Ogilvie's syndrome is a rare but potentially fatal complication that can mimic a postoperative ileus. It is likely underdiagnosed in the lateral transpsoas approach population because of its uncommon nature and a high index of suspicion should remain. Neostigmine can be administered safely under close observation with immediate and successful outcomes. Patients with perforation require urgent laparotomy and primary repair.

Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer

For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population. The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes. From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18months). The median age and tumor size was 72years and 2.5cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7months. The DFS rate was 58.3% and 53.2% at 1 and 3years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0months; P=.02) and OS (31.4 vs 14.3months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and "elsewhere lung" (20.8%). The median time to each was 5 to 7months. From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50Gy) with chemotherapy should be considered a standard option.

A multi-institutional experience in adventitial cystic disease

BackgroundAdventitial cystic disease (ACD) is an unusual arteriopathy; case reports and small series constitute the available literature regarding treatment. We sought to examine the presentation, contemporary management, and long-term outcomes using a multi-institutional database. MethodsUsing a standardized database, 14 institutions retrospectively collected demographics, comorbidities, presentation/symptoms, imaging, treatment, and follow-up data on consecutive patients treated for ACD during a 10-year period, using Society for Vascular Surgery reporting standards for limb ischemia. Univariate and multivariate analyses were performed comparing treatment methods and factors associated with recurrent intervention. Life-table analysis was performed to estimate the freedom from reintervention in comparing the various treatment modalities. ResultsForty-seven patients (32 men, 15 women; mean age, 43 years) were identified with ACD involving the popliteal artery (n = 41), radial artery (n = 3), superficial/common femoral artery (n = 2), and common femoral vein (n = 1). Lower extremity claudication was seen in 93% of ACD of the leg arteries, whereas patients with upper extremity ACD had hand or arm pain. Preoperative diagnosis was made in 88% of patients, primarily using cross-sectional imaging of the lower extremity; mean lower extremity ankle-brachial index was 0.71 in the affected limb. Forty-one patients with lower extremity ACD underwent operative repair (resection with interposition graft, 21 patients; cyst resection, 13 patients; cyst resection with bypass graft, 5 patients; cyst resection with patch, 2 patients). Two patients with upper extremity ACD underwent cyst drainage without resection or arterial reconstruction. Complications, including graft infection, thrombosis, hematoma, and wound dehiscence, occurred in 12% of patients. Mean lower extremity ankle-brachial index at 3 months postoperatively improved to 1.07 (P < .001), with an overall mean follow-up of 20 months (range, 0.33-9 years). Eight patients (18%) with lower extremity arterial ACD required reintervention (redo cyst resection, one; thrombectomy, three; redo bypass, one; balloon angioplasty, three) after a mean of 70 days with symptom relief in 88%. Lower extremity patients who underwent cyst resection and interposition or bypass graft were less likely to require reintervention (P = .04). One patient with lower extremity ACD required an above-knee amputation for extensive tissue loss. ConclusionsThis multi-institutional, contemporary experience of ACD examines the treatment and outcomes of ACD. The majority of patients can be identified preoperatively; surgical repair, consisting of cyst excision with arterial reconstruction or bypass alone, provides the best long-term symptomatic relief and reduced need for intervention to maintain patency.

Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non-small cell lung tumors.

Stereotactic body radiotherapy (SBRT) is the standard of care for patients with nonoperative, early-stage non-small cell lung cancer (NSCLC) measuring < 5 cm, but its use among patients with tumors measuring ≥5 cm is considerably less defined, with the existing literature limited to small, single-institution reports. The current multi-institutional study reported outcomes evaluating the largest such population reported to date. Clinical/treatment characteristics, outcomes, toxicities, and patterns of failure were assessed in patients with primary NSCLC measuring ≥5 cm without evidence of distant/lymph node metastasis who underwent SBRT using ≤5 fractions. Statistics included Kaplan-Meier survival analyses and univariate/multivariate Cox proportional hazards models. A total of 92 patients treated from 2004 through 2016 were analyzed from 12 institutions. The median follow-up was 12 months (15 months in survivors). The median age and tumor size among the patients were 73 years (range, 50-95 years) and 5.4 cm (range, 5.0-7.5 cm), respectively. The median dose/fractionation was 50 Gray/5 fractions. The actuarial local control rates at 1 year and 2 years were 95.7% and 73.2%, respectively. The disease-free survival rate was 72.1% and 53.5%, respectively, at 1 year and 2 years. The 1-year and 2-year disease-specific survival rates were 95.5% and 78.6%, respectively. The median, 1-year, and 2-year overall survival rates were 21.4 months, 76.2%, and 46.4%, respectively. On multivariate analysis, lung cancer history and pre-SBRT positron emission tomography maximum standardized uptake value were found to be associated with overall survival. Posttreatment failures were most commonly distant (33% of all disease recurrences), followed by local (26%) and those occurring elsewhere in the lung (23%). Three patients had isolated local failures. Grade 3 to 4 toxicities included 1 case (1%) and 4 cases (4%) of grade 3 dermatitis and radiation pneumonitis, respectively (toxicities were graded according to the Common Terminology Criteria for Adverse Events [version 4.0]). Grades 2 to 5 radiation pneumonitis occurred in 11% of patients. One patient with a tumor measuring 7.5 cm and a smoking history of 150 pack-years died of radiation pneumonitis. The results of the current study, which is the largest study of patients with NSCLC measuring ≥5 cm reported to date, indicate that SBRT is a safe and efficacious option. Cancer 2017;123:688-696. © 2016 American Cancer Society.

Remote Access Robotic Facelift Thyroidectomy: A Multi‐institutional Experience

Robotic facelift thyroidectomy (RFT) was developed as a new surgical approach to the thyroid gland using a remote incision site. Early favorable results led to this confirmatory multi-institutional experience. Prospectively collected data on consecutive patients undergoing RFT in five North American academic endocrine surgical practices were compiled. Surgical indications, operative times, final pathology, nodule size, complications, and postoperative management (drain use and length of hospital stay) were evaluated. A total of 102 RFT procedures were undertaken in 90 patients. All but one of the patients (98.9%) were female, and the mean age was 41.9±13.1years (range 12-69years). The indication for surgery was nodular disease in 91.2% of cases; 8.8% were completion procedures performed for a diagnosis of cancer. The mean size of the largest nodule was 1.9cm (range 0-5.6cm). The mean total operative time for a thyroid lobectomy was 162min (range 82-265min). No permanent complications occurred. There were 4 cases (3.9%) of transient recurrent laryngeal nerve weakness, no cases of hypocalcemia, and 3 (2.9%) hematomas. There were no conversions to an anterior cervical approach. The majority of patients were managed on an outpatient basis (61.8%) and without a drain (65.7%). RFT is technically feasible and safe in selected patients. RFT can continue to be offered to carefully selected patients as a way to avoid a visible cervical scar. Future prospective studies to compare this novel approach to other remote access approaches are warranted.

Radiosurgical Management of Primary Central Nervous System Lymphoma—A Multi-Institutional Experience

Radiosurgical Management of Primary Central Nervous System Lymphoma—A Multi-Institutional Experience

Stereotactic laser ablation as treatment for brain metastases that recur after stereotactic radiosurgery: a multiinstitutional experience.

OBJECTIVE Therapeutic options for brain metastases (BMs) that recur after stereotactic radiosurgery (SRS) remain limited. METHODS The authors provide the collective experience of 4 institutions where treatment of BMs that recurred after SRS was performed with stereotactic laser ablation (SLA). RESULTS Twenty-six BMs (in 23 patients) that recurred after SRS were treated with SLA (2 patients each underwent 2 SLAs for separate lesions, and a third underwent 2 serial SLAs for discrete BMs). Histological findings in the BMs treated included the following: breast (n = 6); lung (n = 6); melanoma (n = 5); colon (n = 2); ovarian (n = 1); bladder (n = 1); esophageal (n = 1); and sarcoma (n = 1). With a median follow-up duration of 141 days (range 64-794 days), 9 of the SLA-treated BMs progressed despite treatment (35%). All cases of progression occurred in BMs in which < 80% ablation was achieved, whereas no disease progression was observed in BMs in which ≥ 80% ablation was achieved. Five BMs were treated with SLA, followed 1 month later by adjuvant SRS (5 Gy daily × 5 days). No disease progression was observed in these patients despite ablation efficiency of < 80%, suggesting that adjuvant hypofractionated SRS enhances the efficacy of SLA. Of the 23 SLA-treated patients, 3 suffered transient hemiparesis (13%), 1 developed hydrocephalus requiring temporary ventricular drainage (4%), and 1 patient who underwent SLA of a 28.9-cm3 lesion suffered a neurological deficit requiring an emergency hemicraniectomy (4%). Although there is significant heterogeneity in corticosteroid treatment post-SLA, most patients underwent a 2-week taper. CONCLUSIONS Stereotactic laser ablation is an effective treatment option for BMs in which SRS fails. Ablation of ≥ 80% of BMs is associated with decreased risk of disease progression. The efficacy of SLA in this setting may be augmented by adjuvant hypofractionated SRS.