Abhishek Trehan

University of Oxford

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Mahiben Maruthappu

Imperial College London

Peter McCulloch

University of Oxford

Ashton Barnett‐Vanes

NHS Lothian

Matthew J. Carty

Brigham and Women's Hospital

Tobias Maurer

Martini-Klinik

Martin Umbehr

Triemli Hospital

Atsushi Takenaka

Tottori University

Alberto Molinari

Ospedale Sacro Cuore Don Calabria

D. Baumunk

Deutsche Gesellschaft für Urologie

Martin Schostak

Otto-von-Guericke University Magdeburg

Cooperative Institutions

Charité - Universitätsmedizin Berlin

Klinik und Poliklinik für Urologie

München Klinik

Tokyo Medical and Dental University

Technical University of Munich

Klinikum rechts der Isar

University Hospital of Zurich

Azienda Ospedaliera Universitaria Integrata Verona

Otto-von-Guericke University Magdeburg

National Research Center for Hematology Russian Academy of Medical Sciences

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Comparison of Off-Clamp Partial Nephrectomy and On-Clamp Partial Nephrectomy: A Systematic Review and Meta-Analysis

Urologia Internationalis (2014)

Abhishek Trehan

Objective: To compare peri- and postoperative variables, surgical complications, oncological outcomes and renal outcomes of off-clamp partial nephrectomy (PN) and on-clamp PN. Methods: A systematic search of the electronic databases, including MEDLINE, Embase and Cochrane Library, was performed. The pooled estimates of tumour size, operative time, estimated blood loss, length of stay, overall complications, transfusion rates, urinary leaks, positive surgical margins and eGFR were calculated. Results: 14 studies were included. There was no significant difference between off-clamp PN and on-clamp PN in terms of tumour size, operative time, estimated blood loss, length of stay, overall complications, transfusion rates, urinary leaks, and positive surgical margins. However, a non-statistically significant trend towards increased blood loss (p = 0.12) and transfusion rates (p = 0.07) in those undergoing off-clamp PN was noted. Off-clamp PN was associated with a significantly lower reduction in eGFR than on-clamp PN (standardised weighted mean difference 0.27, 95% CI 0.14, 0.40, p < 0.0001). Conclusions: Off-clamp PN may be associated with improved long-term renal outcomes when compared to on-clamp PN with no difference in in peri- and postoperative variables, surgical complications and oncological outcomes. However, the meta-analysis was limited by the design of the underlying studies, and hence further work is necessary.

Clamp

10.1159/000362799

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Citations (35)

Temporary ovarian suspension

Gynaecological Endoscopy (2002)

Abhishek Trehan

ABSTRACT Background Following the division of adhesions, ovarian cystectomys, and/or the excision or coagulation of endometriosis, pelvic pain may continue because of re‐formation of adhesions between the posterior surface of the ovary and the ovarian fossa. Various methods of adhesion prevention, such as the use of Interceed, Intergel or heparinized saline etc., have proved unsuccessful. Temporary ovarian suspension is a simple technique of suspending the ovary, for 5–7days, by attachment to the anterior abdominal wall. This allows separation of the raw area on the ovary and the ovarian fossa until surface epithelialization has occurred. When the suture is removed, the ovary falls back to its anatomical position. Objective To describe and discuss this simple technique of suspending the ovaries. Intervention The anterior abdominal wall is transilluminated with the laporoscope to demonstrate any major blood vessels, especially the inferior epigastric vessels. The junction of the lateral one‐quarter and the medial three‐quarters, approximately 1 inch above the inguinal ligament is the site on the anterior abdominal wall used for ovarian suspension. Non‐absorbable number 0 Prolene on a straight needle is used for suturing. The needle is pushed into the abdominal cavity at the abovementioned site; it picks up the ovary and comes out of the abdominal wall at the same site. The thread is tied on the anterior abdominal wall, with appropriate adjustment of the tension. The stitch is covered with a transparent dressing which is left in position until the day of removal of the stitch.

Abdominal cavity

10.1046/j.1365-2508.2002.00520.x

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Citations (5)

PS1178 TREATMENT AND OUTCOME OF CHRONIC MYELOID LEUKEMIA IN CHILDREN AND ADOLESCENTS: THE INDIAN PEDIATRIC ONCOLOGY GROUP-CML-16–01 MULTICENTRIC STUDY

HemaSphere (2019)

Sidharth Totadri Ajay Mahajan Vedant Gupta Aditi Das Jagdish Prasad Meena

Background: About 50% of chronic myeloid leukemia (CML) patients (pts) after TKI discontinuation lose a major molecular response (MMR) and should return to therapy. Despite the fact that, after TKI resumption, almost all pts re-achieve deep molecular remission, facilitating a more accurate selection process for therapy cessation remains topical Aims: To define the prognostic factors for molecular relapse-free survival after TKI discontinuation in Russian CML population Methods: The base for the analysis was the Russian multicenter prospective study RU-SKI on the discontinuation of TKI in pts with CML and deep molecular response (DMR). Ninety-eight CML pts with chronic phase (CP), TKI therapy for at least three years and a stable DMR (BCR-ABL<0.01%) for at least two years were enrolled. Pts with previous imatinib failure and treatment-free remission (TFR) failure were eligible. The BCR-ABL level was evaluated by RQ-PCR according to the international scale (IS). The schedule of molecular tests was as follows: monthly during the first six months (mo) after TKI cessation, every two mo from six to 12 mo and every three mo thereafter. Treatment by the same TKI was resumed in case of MMR loss (BCR-ABL>0.1%). We used the proportional hazards regression analysis to identify independently significant factors for molecular relapse-free survival (MRFS). We categorized each independently significant factor into two groups, depending on the optimal cutoff level obtained by the minimum P-value approach. We used the Kaplan-Meier method for calculating the probability of MRFS and the log-rank test for comparison. Results: One year MRFS in all group was 51%. MRFS rate in pts with history of previous TFR failure (n = 7) was 14%. We decided to exclude from multivariate analysis pts with history of previous TFR failure to identify significant factors for the first attempt of therapy cancellation. Baseline pts characteristics (1st stop, n = 91): male: 48%; median (Me) age at TKI cessation 46 years (range 22 to 80); Me duration of TKI therapy 8.3 years (range three to 16.2); Me duration of DMR 3.2 years (range two to 10.7). Therapy before treatment cessation: imatinib in 63 (69%) pts, second-generation (2G) TKI in 28 (31%) pts. Me follow-up time after TKI cessation was 24 mo (range 12 to 41). Probability of MRFS (1st stop) was 55% after 12 mo of follow-up. We include in multivariate analysis the following factors: age, gender, history of previous resistance to imatinib, type and line of TKI, duration of therapy, length of DMR, depth of molecular response before cancellation, Sokal risk group. Sokal risk group, duration of therapy and depth of molecular response were found to be independently significant factors with p ≤0.05. Treatment duration more than 8 years, depth of DMR before cancellation at least MR4.5, non-high Sokal risk group were attributed to favorable factors for MRFS after the optimal cutoff level was obtained (fig.1). We have found that the duration of TKI therapy, and not the duration of DMR has an independent prognostic value for the Russian CML population. The lack of molecular monitoring data at early stages of the disease in long-term treated pts cause to the 1st DMR detection bias. Indeed, a longer time to the 1st DMR was observed in pts with the longer duration of TKI therapy (fig.2).Summary/Conclusion: Patients with treatment duration more than 8 years, depth of DMR before cancellation at least MR4.5, non-high Sokal risk group and without history of previous TFR failure are more preferable for TKI discontinuation

Discontinuation

10.1097/01.hs9.0000562996.37394.c4

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End-stage renal disease in Indo-Asians in the North-West of England

QJM (2003)

Abhishek Trehan Jean Winterbottom B. Lane Rob Foley M K Venning

The incidence of end-stage renal disease (ESRD) in England is increasing. There is a higher incidence of ESRD in British Indo-Asians than in the White population.To determine to what degree the increasing demand for renal replacement therapy in the UK is due to Indo-Asian patients. To study the presentation to renal services of Indo-Asian patients with ESRD and report any inequalities in initial treatment of Indo-Asian patients with ESRD compared to their White counterparts.Prospective, inception cohort study.Consecutive adult patients with ESRD who started renal replacement therapy between 1 April 2000 and 31 December 2001 in all 14 renal units serving an area from North Cheshire to South Cumbria, including Greater Manchester and Lancashire, were recruited and interviewed.Of the 578 patients, 9.5% were Indo-Asian. The annual acceptance rate for renal replacement therapy was 342 per million population in Indo-Asians, compared with 91 per million population in the White population ( p < 0.001). Indo-Asian patients with ESRD were younger (median age 51 years vs. 60 yrs, p = 0.006) and more socially deprived (81% vs. 36.5% in the 5th Carstairs quintile, p < 0.001). A greater proportion of Indo-Asian patients with ESRD presented late to specialist renal services (31% vs. 19%, p = 0.03). Once adjusting for their younger age, atherosclerotic renovascular disease and/or hypertensive nephropathy was more prevalent in Indo-Asian patients (OR 4.9; p = 0.03). There was no difference in the initial mode of maintenance dialysis or the perception of choice the patients felt they had, based on their ethnicity.There is a silent epidemic of ESRD in Indo-Asian patients in the North-West, possibly vascular in aetiology, in which specialist intervention is late. This suggests that Indo-Asian patients should be prioritized for early intervention strategies to reduce the burden of ESRD.

Renal replacement therapy

10.1093/qjmed/hcg088

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Citations (25)

Comparison of off-clamp partial nephrectomy and on-clamp partial nephrectomy: A systematic review and meta-analysis

International Journal of Surgery (2014)

Abhishek Trehan

Clamp

10.1016/j.ijsu.2014.08.264

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Citations (4)

Assessment of Acute Burn Management in 32 Low‐ and Middle‐Income Countries

World Journal of Surgery (2015)

Krishan Joseph Abhishek Trehan Meena Cherian Edward Kelley David Watters

Debridement (dental)

First aid

10.1007/s00268-015-3355-3

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Citations (9)

The impact of feedback of intraoperative technical performance in surgery: a systematic review

BMJ Open (2015)

Abhishek Trehan Ashton Barnett‐Vanes Matthew J. Carty Peter McCulloch Mahiben Maruthappu

Objectives Increasing patient demands, costs and emphasis on safety, coupled with reductions in the length of time surgical trainees spend in the operating theatre, necessitate means to improve the efficiency of surgical training. In this respect, feedback based on intraoperative surgical performance may be beneficial. Our aim was to systematically review the impact of intraoperative feedback based on surgical performance. Setting MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews were searched. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. 32 data-points per study were extracted. Participants The search strategy yielded 1531 citations. Three studies were eligible, which comprised a total of 280 procedures by 62 surgeons. Results Overall, feedback based on intraoperative surgical performance was found to be a powerful method for improving performance. In cholecystectomy, feedback led to a reduction in procedure time (p=0.022) and an improvement in economy of movement (p<0.001). In simulated laparoscopic colectomy, feedback led to improvements in instrument path length (p=0.001) and instrument smoothness (p=0.045). Feedback also reduced error scores in cholecystectomy (p=0.003), simulated laparoscopic colectomy (p<0.001) and simulated renal artery angioplasty (p=0.004). In addition, feedback improved balloon placement accuracy (p=0.041), and resulted in a smoother learning curve and earlier plateau in performance in simulated renal artery angioplasty. Conclusions Intraoperative feedback appears to be associated with an improvement in performance, however, there is a paucity of research in this area. Further work is needed in order to establish the long-term benefits of feedback and the optimum means and circumstances of feedback delivery.

10.1136/bmjopen-2014-006759

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Citations (86)

Announcement

Urologia Internationalis (2014)

Martin Umbehr Remo A. Largo Sabrina Gfeller Mathias Tremp Cédric Poyet

10.1159/000366141

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Citations (0)

Does feedback of surgical outcome data improve surgical performance? A systematic review

Journal of the American College of Surgeons (2014)

Abhishek Trehan Mahiben Maruthappu Ashton Barnett‐Vanes Matthew Carty Peter McCulloch