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Paul Russo

Publications and source records attributed to Paul Russo.

At least 37 records · Page 2Linked to original sources
PubMed2006

Mini-flank supra-11th rib incision for open partial or radical nephrectomy.

OBJECTIVE: To report our approach to partial (PN) or radical nephrectomy (RN) using a supra-11th mini-flank incision, as the widespread availability of advanced imaging has increased the detection of incidental, lower-stage renal tumours that are generally amenable to resection using smaller incisions. PATIENTS AND METHODS: The study included 167 consecutive patients undergoing PN/RN for renal tumours treated between February 2000 and March 2003 using the supra-11th rib mini-flank approach. Variables analysed were age, gender, nephrectomy type (PN vs RN), operative duration, estimated blood loss (EBL), hospital stay, tumour size and location, pathological stage and histology, perioperative transfusions, and complications. Patients undergoing PN were examined for ischaemia type (cold, warm, none) and duration of renal artery clamping. The interval after surgery to initiate solid diet and discontinue patient-controlled analgesia, and overall pain control, were analysed and compared between PN and RN. RESULTS: In all, 133 patients (80%) underwent PN and 34 (20%) RN, at a median age of 61.7 years. The median operative duration was 2.9 h, the EBL 400 mL, tumour size 3.2 cm and median hospital stay 5 days. At a median follow-up of 18.2 months, there were seven (4%) late complications: six patients had a flank bulge and one had a reducible hernia. Surgical margins were negative in 164 (98%) patients. CONCLUSIONS: The supra-11th rib mini-flank incision offers a practical alternative to traditional open or laparoscopic PN or RN. Using a small (8 cm) incision with no rib resection, this approach affords optimum exposure without compromising cancer control, with excellent cosmetic results and a lower risk of late complications at the wound site.

Adult↗
PubMed2006

Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm.

OBJECTIVE: To compare the outcomes of patients who had a elective partial nephrectomy (PN) or radical nephrectomy (RN) for clear cell renal cell carcinoma (RCC) of 4-7 cm. PATIENTS AND METHODS: From March 1998 to July 2004, 45 and 151 patients underwent PN and RN, respectively, for clear cell RCC. A multivariate Cox model was constructed for disease-free survival with adjustment for markers of disease severity, and a propensity-score approach used as a confirmatory analysis. RESULTS: In the PN and RN cohorts the treatment failed in one and 20 patients, respectively; the median follow-up was 21 months. The hazard ratio (95% confidence interval) for PN after adjusting for disease severity was 0.36 (0.05-2.82; P = 0.3). Using planned PN as a predictor (intent-to-treat analysis) the hazard ratio was 1.06 (0.32-3.53; P = 0.9). In the propensity-score model, planned PN was associated with a hazard ratio of 1.75 (0.50-6.14; P = 0.4). The serum creatinine level 3 months after surgery was significantly lower in patients who had PN, with a difference between the means of 0.36 (0.23-0.48; P < 0.001). CONCLUSIONS: Renal function was preserved after PN for 4-7 cm clear cell RCC tumours. When comparing the outcomes of PN and RN it is important to consider the intended operation as an independent variable. There was no clear evidence that PN was associated with worse cancer control, although a continued follow-up of this and other cohorts is warranted.

Carcinoma, Renal Cell↗
PubMed2006

Renal cell carcinoma local recurrences: impact of surgical treatment and concomitant metastasis on survival.

OBJECTIVE: To analyse the survival benefit of resecting local recurrence (LR) of renal cell carcinoma (RCC) in the presence and absence of concomitant metastasis. PATIENTS AND METHODS: From 1989 to 2004 we identified 34 patients with LRs (2.9%) of the 1165 radical nephrectomies performed for T1-4N0M0 disease. Of these, 18 (53%) had no evidence of metastasis (isolated LR incidence, 1.5%) and 16 (47%) had synchronous metastasis. Of the 18 patients with no metastasis, 11 had complete surgical resection (group I) and seven had nonsurgical therapy (group II). Of the 16 patients with synchronous metastasis, five had surgery (group III) and 11 did not (group IV). Survival was projected using the Kaplan-Meier method and log-rank test for each group. RESULTS: Eight of the 34 patients (24%) were symptomatic. The T stage of the initial nephrectomy was T1a in two cases, T1b in six, T2 in five, T3a in six, T3b in eight, T4 in six and unknown in one; 22 patients (65%) had clear cell histology. There were no significant differences in median time to LR or the LR size among the groups. The median (range) follow-up was 16.9 (0.5-103.6) months. Of the 11 patients in group I, three remain with no evidence of disease, three are alive with metastatic disease, and five died from disease. By contrast, 21 of the 23 patients (91%) in groups II, III and IV died from disease. The overall estimated 1-, 3- and 5-year survivals were 63%, 31% and 18%. The median survival time was 71.4 months for group I, 9.9 for II, 16.3 for III, and 11.8 for IV (P < 0.01) with a 5-year survival of 62% for group I and 0% for groups II, III, and IV. CONCLUSIONS: LR after radical nephrectomy is rare (2.9%) and has a poor prognosis. The presence of synchronous metastasis and nonoperative therapy are related to these low survival rates. However, if there is no metastatic disease, complete surgical resection of LRs is associated with improved survival.

Adult↗
PubMed2006

The impact of tumour location on the histological subtype of renal cortical tumours.

OBJECTIVE: To determine whether the location of renal cortical tumours (RCTs) is a possible factor affecting tumour behaviour, by investigating whether exophytic vs a central location is associated with a difference in histological subtype distribution, as recognized prognostic factors for RCTs include size, stage, grade, and histological subtype. PATIENTS AND METHODS: Between 1 January 1996 and 1 June 2003, we evaluated 485 consecutive RCTs in 469 patients who had renal imaging studies and underwent either partial or radical nephrectomy at our institution. A radiologist and a urologist independently reviewed the imaging studies of all patients to determine exophytic vs central location. An exophytic lesion was defined as one that clearly both pushed out the renal contour and did not extend into the collecting system, hilum, or renal sinus. A lesion that did not meet these criteria was defined as a central lesion. Logistic regression analysis was used to determine if either type of lesion had a greater representation of any histological subtype. A two-tailed P < or = 0.05 was considered to indicate significance. RESULTS: Of the 485 RCTs, 171 (35%) were exophytic and 314 (65%) were central, while 308 (64%) were clear cell and 177 (36%) were non-clear cell tumour histology. Of the exophytic lesions, 52.0% were clear cell, while 69.7% of central lesions were clear cell (P < 0.001). Conversely, 71.1% of clear cell tumours were central, while 53.7% of non-clear cell tumours were central (P = 0.003). After controlling for size and stage, tumour location remained associated with histological subtype (P = 0.003). CONCLUSIONS: Exophytic lesions are significantly more likely than central lesions to be non-clear cell tumours, and clear cell tumours are significantly more likely than non-clear cell tumours to be central. As studies indicate that the clear cell histological subtype portends a worse prognosis than the non-clear cell subtype, our results imply that tumour location affects the prognosis in RCTs, with exophytic lesions having a better prognosis than central lesions. This result may have important implications for physicians and patients when planning partial vs radical nephrectomy by either open or minimally invasive techniques.

Carcinoma, Renal Cell↗
PubMed2006

Diagnostic and therapeutic procedures for management of melanoma during pregnancy: risks for the fetus?

In the treatment of malignant melanoma, various stage-dependent diagnostic and therapeutic procedures are widely accepted. The situation becomes more complicated in pregnant women due to potential hazardous side effects to the fetus. We report on a 36-year-old woman, who was admitted with a high-risk malignant melanoma on the right cheek. Prior to surgery we performed computed tomography (CT)-scans that were unremarkable with the exception of "two small cysts of the uterus" The primary melanoma was excised and a sentinel node biopsy was performed under general anesthesia using radioactive tracers. Afterwards, adjuvant therapy with interferon alpha 2b was initiated. Five weeks later our patient reported that she was pregnant with twins in their eleventh week of gestation, although she previously denied several questions regarding a potential pregnancy. She declined the offer of an abortion and elected to continue with the interferon treatment against our medical advice. In the 36(th) week of gestation, she developed regional lymph node metastases. Consequently, labor was induced, resulting in the delivery of healthy twins. Six months later our patient developed lung metastases. Despite several chemotherapy regimens, she died one year later. An interdisciplinary approach to obtaining informed consent and managing female high risk melanoma patients with potential or present pregnancy is presented.

Female↗
PubMed2006

Partial nephrectomy achieves local tumor control and prevents chronic kidney disease.

Over the last 10 years, a rapidly changing clinical landscape has created an optimal environment to expand the use of partial nephrectomy for the treatment of renal cortical tumors. The main factors responsible for the increasing use of partial nephrectomy relate to the appreciation of the diversity of renal cortical tumor histology, the tumor stage and size migration associated with their incidental detection, and the oncological efficacy of partial nephrectomy for tumors of 7 cm or smaller. Evidence has now emerged that radical nephrectomy performed during the treatment of a small renal mass may further reduce an already impaired baseline renal function and place the patient in the realm of chronic kidney disease. Important new information concerning chronic kidney disease, a condition far more prevalent in the aging US population than previously appreciated, and its associated cardiovascular morbidity and mortality, now places maximal renal functional preservation on a par with local tumor control as surgical plans are formulated for the resection of a small renal cortical tumor.

Adenocarcinoma, Clear Cell↗
PubMed2005

A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma.

PURPOSE: Few published studies have simultaneously analyzed multiple prognostic factors to predict recurrence after surgery for conventional clear cell renal cortical carcinomas. We developed and performed external validation of a postoperative nomogram for this purpose. We used a prospectively updated database of more than 1,400 patients treated at a single institution. MATERIALS AND METHODS: From January 1989 to August 2002, 833 nephrectomies (partial and radical) for renal cell carcinoma of conventional clear cell histology performed at Memorial Sloan-Kettering Cancer Center were reviewed from the center's kidney database. Patients with von Hippel-Lindau disease or familial syndromes, as well as patients presenting with synchronous bilateral renal masses, or distant metastases or metastatic regional lymph nodes before or at surgery were excluded from study. We modeled clinicopathological data and disease followup for 701 patients with conventional clear cell renal cell carcinoma. Prognostic variables for the nomogram included pathological stage, Fuhrman grade, tumor size, necrosis, vascular invasion and clinical presentation (ie incidental asymptomatic, locally symptomatic or systemically symptomatic). RESULTS: Disease recurrence was noted in 72 of 701 patients. Those patients without evidence of disease had a median and maximum followup of 32 and 120 months, respectively. The 5-year probability of freedom from recurrence for the patient cohort was 80.9% (95% confidence interval 75.7% to 85.1%). A nomogram was designed based on a Cox proportional hazards regression model. Following external validation predictions by the nomogram appeared accurate and discriminating, and the concordance index was 0.82. CONCLUSIONS: A nomogram has been developed that can be used to predict the 5-year probability of freedom from recurrence for patients with conventional clear cell renal cell carcinoma. This nomogram may be useful for patient counseling, clinical trial design and effective patient followup strategies.

Carcinoma, Renal Cell↗
PubMed2004

Phase II trial of bortezomib for patients with advanced renal cell carcinoma.

PURPOSE: To assess the efficacy and toxicity of bortezomib (Velcade; Milennium Pharmaceuticals Inc, Cambridge, MA; formerly PS-341) in patients with metastatic renal cell carcinoma (RCC). PATIENTS AND METHODS: Thirty-seven patients with metastatic RCC were treated with bortezomib. The first 25 patients enrolled onto the trial were treated with a dose of 1.5 mg/m2. The dose was decreased to 1.3 mg/m2 for the subsequent 12 patients, because more than 50% of the patients treated at the higher dose required dose reductions. Bortezomib was given by intravenous administration on a twice-weekly schedule for 2 weeks followed by 1 week without treatment until progression or unacceptable toxicity occurred. Twenty-three patients (62%) previously had undergone nephrectomy, and 19 patients (51%) had previously been treated with cytokine therapy. RESULTS: Of the 37 assessable patients, the best response was a partial response in four patients (11%; 95% CI, 3% to 25%) and stable disease in 14 patients (38%; 95% CI, 23% to 55%). The four patients with partial response experienced response durations of 8, 8+, 15+, and 20+ months. Grade 2 or 3 sensory neuropathy was present in 10 patients (53%) overall. One patient in the 1.5 mg/m2 group had grade 3 sensory neuropathy; no grade 3 sensory neuropathy was seen in the 1.3 mg/m2 group. CONCLUSION: The results of this trial suggest that bortezomib has an antitumor effect in individual patients with metastatic RCC. The small proportion of patients who achieved a partial response does not support routine use in metastatic RCC. Efforts to identify the molecular profile associated with clinical response or combination therapy with interferon alfa or other novel agents, may be considered.

Adult↗
PubMed2004

Cyclooxygenase-2 and microsomal prostaglandin E synthase-1 are overexpressed in squamous cell carcinoma of the penis.

PURPOSE: Prostaglandin E2 (PGE2) promotes malignant growth. Cyclooxygenase (COX) catalyzes the synthesis of PGH2, which is converted, in turn, by microsomal prostaglandin E synthase (mPGES-1) to PGE2. One strategy for inhibiting carcinogenesis is to prevent PGE2 production in premalignant and malignant tissues. It is important, therefore, to determine whether enzymes involved in PGE2 biosynthesis are deregulated in neoplasia. The main purpose of this study was to determine whether amounts of COX-2 or mPGES-1 were increased in intraepithelial neoplasia or squamous cell carcinoma (SCC) of the penis. Because human papillomavirus (HPV) has been linked to the development of penile SCC, a secondary objective was to determine whether COX-2 was overexpressed in SCC arising in an HPV16 transgenic mouse. EXPERIMENTAL DESIGN: Immunohistochemistry and immunoblotting were used to evaluate the expression of COX-2 and mPGES-1 in benign and malignant lesions including metastases to lymph nodes. Amounts of intratumoral PGE2 were quantified by enzyme immunoassay. Reverse transcription-PCR was used to determine the expression of each of the four known receptors (EP(1-4)) for PGE2. RESULTS: Immunohistochemistry demonstrated increased expression of COX-2 and mPGES-1 in dysplasia, carcinoma in situ, invasive SCC, and metastases to lymph nodes. Immunoblot analysis confirmed that COX-2 and mPGES-1 were consistently overexpressed in SCC. PGE2 and all four of the PGE2 receptor subtypes were detected in each of the tumor samples. Elevated levels of COX-2 were also detected in SCC arising in an HPV16 transgenic mouse. CONCLUSIONS: Increased amounts of COX-2 and mPGES-1 were detected in penile intraepithelial neoplasia and carcinoma. These findings provide the basis for evaluating whether inhibiting COX-2 will be useful in the prevention or treatment of penile SCC.

Animals↗
PubMed2004

Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma.

PURPOSE: To describe survival in previously treated patients with metastatic renal cell carcinoma (RCC) who are candidates for clinical trials of new agents as second-line therapy. PATIENTS AND METHODS: The relationship between pretreatment clinical features and survival was studied in 251 patients with advanced RCC treated during 29 consecutive clinical trials between 1975 and 2002. Clinical features were first examined in univariate analyses, and then a stepwise modeling approach based on Cox regression was used to form a multivariate model. RESULTS: Median survival for the 251 patients was 10.2 months and differed according to year of treatment, with patients treated after 1990 showing longer survival. In this group, the median overall survival time was 12.7 months. Because the purpose of this analysis was to establish prognostic factors for present-day clinical trial design, prognostic factor analysis was performed on these patients. Pretreatment features associated with a shorter survival in the multivariate analysis were low Karnofsky performance status, low hemoglobin level, and high corrected serum calcium. These were used as risk factors to categorize patients into three different groups. The median time to death in patients with zero risk factors was 22 months. The median survival in patients with one of these prognostic factors was 11.9 months. Patients with two or three risk factors had a median survival of 5.4 months. CONCLUSION: Treatment with novel agents during a clinical trial is indicated for patients with metastatic RCC after progression to cytokine treatment. Three prognostic factors for predicting survival were used to categorize patients into risk groups. These risk categories can be used in clinical trial design and interpretation.

Adolescent↗
PubMed2004

Effect of papillary and chromophobe cell type on disease-free survival after nephrectomy for renal cell carcinoma.

BACKGROUND: The clinical staging of renal cortical tumors traditionally has not evaluated the potential effect of histological subtypes on survival. Evidence suggests that conventional clear cell renal cell carcinoma (RCC) and nonconventional clear cell RCC (chromophobe and papillary) have different metastatic potential. Using a large renal tumor database, we examined the effect of tumor histology on the pattern of metastasis and patient survival. METHODS: All patients with nonmetastatic renal cortical tumors undergoing partial or radical nephrectomy were identified from a renal tumor database between July 1989 and July 2002. Kaplan-Meier and Cox regression tests were used for statistical analysis. RESULTS: Analysis revealed 1057 patients: 794 with conventional clear cell RCC, 157 with papillary RCC, and 106 with chromophobe RCC. Metastasis occurred in 95 conventional clear cell RCC, 9 papillary RCC, and 6 chromophobe RCC with a median follow-up of 34.6, 43.0, and 33.2 months, respectively. Using log-rank analysis, chromophobe and papillary RCC were associated with an improved disease-free survival at 5 years (P =.009 and.015, respectively). Multivariate analysis revealed tumor size, stage, and chromophobe histology as significant variables for disease progression. CONCLUSIONS: Renal cortical tumors have distinct histological subtypes with varying degrees of metastatic potential. Conventional clear cell RCC, which comprises two thirds of renal cortical tumors presenting with localized disease, has a less favorable outcome when compared with papillary and chromophobe RCC. Controlling for size and stage, chromophobe, and not papillary, RCC was a significant variable for disease progression compared with conventional clear cell RCC. Knowledge of renal cortical tumor histological subtype is critical for projecting prognosis, tailoring follow-up strategies, and designing clinical trials.

Adult↗
PubMed2004

Mucinous adenocarcinoma of the prostate: a case report of long-term disease-free survival and a review of the literature.

A 65-year-old man presented with hematuria, postcoital bleeding, and mucoid-appearing prostatic secretions. The prostate was normal in size, boggy, and with no palpable masses. Cystoscopy revealed a prostatic wall cavity with gelatinous material exuding from the lesion. Extensive transurethral resection was performed, with approximately 37 g of tissue retrieved. Flexible sigmoidoscopy was performed to 60 cm, revealing no lesions, and stool was negative for occult blood. The pathologic diagnosis was mucinous adenocarcinoma of the prostate. Computed tomography and bone scan were negative for metastatic disease. The patient underwent uncomplicated radical prostatectomy. Fifteen years later, the patient was disease free and maintaining a healthy, active lifestyle.

Adenocarcinoma, Mucinous↗
PubMed2004

Surgical intervention in patients with metastatic renal cancer: current status of metastasectomy and cytoreductive nephrectomy.

It is estimated that in 2004 there will be 35,700 new cases of, and 12,480 deaths from, kidney cancer in the US. Since 1950 there has been a 126% increase in the incidence of renal cancer and a 36.5% increase in annual associated mortality. In the past two decades, our understanding of tumors arising from the renal cortex has dramatically expanded owing to advances in cytogenetics and histopathological reclassification. It is now known that renal cell carcinoma (RCC) is a family of neoplasms that possess unique molecular and cytogenetic defects, with 90% of metastases emanating from conventional clear cell carcinoma subtype. In addition to advancing our understanding of RCC, improved abdominal imaging technology has caused a migration of tumor stage and alteration of surgical strategies, with tumors commonly being diagnosed at an earlier stage. Despite these advances, the prognosis for patients with metastatic RCC is poor. Studies that examine combinations of surgery and systemic therapy aim to improve survival in this high-risk group.

Carcinoma, Renal Cell↗
PubMed2004

Complications of radical and partial nephrectomy in a large contemporary cohort.

PURPOSE: Standardized criteria for reporting the early complications of urological procedures are lacking. We reviewed the early complications of radical nephrectomy (RN) and partial nephrectomy (PN) in a large contemporary cohort using a standardized complication grading scale. MATERIALS AND METHODS: Between 1995 and 2002, 1,049 patients underwent RN (66%) or PN (34%) for renal cortical neoplasm. Records were reviewed for perioperative complications. Complications were graded using a 5-tiered scale based on the severity of impact or intensity of therapy required. RESULTS: A total of 235 complications occurred in 180 patients (17%). Overall 55% and 31% of complications were grade I and grade II, respectively. There were 3 perioperative deaths (0.2%). PN was not associated with more complications compared to RN when accounting for other variables. PN cases had more procedure related complications compared to RN (9% versus 3%, respectively, p = 0.0001) due to complications of urinary leak and the reintervention rate was subsequently higher (2.5% versus 0.6%, p = 0.02). All but 1 of the reinterventions for PN involved either endoscopy or radiology. By multivariate analysis operative time (p <0.0001) and solitary kidney (p = 0.06) were associated with procedure related complications of PN. CONCLUSIONS: RN and PN are associated with low rates of serious morbidity and mortality. Compared to RN, PN is associated with higher rates of procedure related complications, the majority of which are minor. Overall, however, PN is not associated with more complications than RN.

Adolescent↗