but one intracranial hemorrhage event due to tPA delivered by USCDT did occur.
J Urol. 2018 Oct;200(4):731–736. doi: 10.1016/j.juro.2018.04.015. Epub 2018 Apr 11.
Is routine renal tumor biopsy associated with lower rates of benign histology following nephrectomy for small renal masses?
Richard PO, Lavallée LT, Pouliot F, Komisarenko M, Martin L, Lattouf JB, Finelli A.
PURPOSE: Renal tumor biopsies have been proposed as a management alternative to avoid treatment of benign or low-risk small renal masses. However, many urologists are reluctant to recommend renal tumor biopsy because they feel its result frequently will not impact management. Our primary objective was to evaluate if centers that routinely favor renal tumor biopsy have lower rates of benign histology after surgery than centers where a selective renal tumor biopsy approach is used.
MATERIALS AND METHODS: This was a retrospective multicenter study of patients who underwent partial or radical nephrectomy for a lesion suspicious for localized renal cell carcinoma which measured 4 cm or less (cT1a and pT1a or pT3a) between 2013 and 2015. A logistic regression model was used to examine whether the odds of obtaining a benign tumor following surgery differed between centers that routinely favor renal tumor biopsy and centers where a selective renal tumor biopsy approach is used.
RESULTS: A total of 542 small renal masses in 516 patients were included in study. The rate of histologically benign tumors after surgery was 11 percent. This rate was significantly lower at centers that routinely favor renal tumor biopsy than at centers where a selective renal tumor biopsy approach is used (5 percent vs. 16 percent, p<0.001). On multivariable analysis older age, smaller tumors and centers where a selective renal tumor biopsy approach is used were significantly associated with greater odds of finding a histologically benign tumor postoperatively. Compared to centers that routinely favor renal tumor biopsy, the odds of finding a benign tumor at surgery was 4 times more likely at centers where a selective renal tumor biopsy approach is used (OR 4.1, 95 percent CI 1.9-8.3).
CONCLUSIONS: Routine renal tumor biopsy reduces surgery for benign tumors and the potential for short-term and long- term morbidity associated with these procedures. This study suggests that routine renal tumor biopsy may be a valuable tool to decrease overtreatment of small renal masses.
J Trauma Acute Care Surg. 2018 Aug;85(2):290–297. doi: 10.1097/ TA.0000000000001906.
Influence of postoperative hepatic angiography on mortality after laparotomy in Grade IV/V hepatic injuries.
Matsumoto S, Cantrell E, Jung K, Smith A, Coimbra R.
BACKGROUND: Mortality rate for severe liver injuries remains high. As an adjunct to surgery, postoperative hepatic angiography (PHA) may have a positive impact on outcomes. This study sought to compare outcomes following surgical management of severe liver injuries with and without PHA using propensity score matching analysis.
METHODS: Data from the National Trauma Data Bank from 2007 to 2014 were analyzed. The study population consisted of patients older than 18 years, sustaining severe liver injuries (i.e., American Association for the Surgery of Trauma Organ Injury Scale [AAST-OIS] Grade IV or V) who underwent surgery. Patients were divided into two groups. The PHA group consisted of those undergoing surgery followed by PHA. In the surgery-only group, no angiography was performed. To determine the impact of PHA on outcomes, propensity score matching analysis (1:3) was used.
RESULTS: A total of 3,871 patients met inclusion criteria. Of those, 205 (5.3 percent) patients underwent PHA. Prior to matching, patients in the PHA group had higher severity, but overall in-hospital mortality was found to be similar between the two groups. After 1:3 propensity-score matching, 196 patients in the PHA group were matched with 588 in the surgery-only group with well-balanced baseline characteristics. The in-hospital mortality was significantly lower in the PHA group compared with the surgery-only group (24.5 percent vs. 35.9 percent; odds ratio, 0.58; 95 percent confidence interval, 0.40–0.84). However, hospital length of stay was longer (16.0 [7.0–29.8] vs. 11 [1.0–25.0] days, p = 0.001), and the incidence of deep and organ/space surgical site infection (3.6 percent vs. 1.2 percent, 8.2 percent vs. 3.5 percent, respectively) was higher in the PHA group.
CONCLUSION: The use of PHA was associated with decreased mortality rates. A multimodality approach using both surgical intervention followed by PHA appears to identify patients that may benefit from arterial embolization, leading to decreased mortality of severe liver injuries.
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