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Article: The Prognostic Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Small Renal Cell Carcinomas after Image-Guided Cryoablation or Radio-Frequency Ablation.

Asif, Aqua / Chan, Vinson Wai-Shun / Osman, Filzah Hanis / Koe, Jasmine Sze-Ern / Ng, Alexander / Burton, Oliver Edward / Cartledge, Jon / Kimuli, Michael / Vasudev, Naveen / Ralph, Christy / Jagdev, Satinder / Bhattarai, Selina / Smith, Jonathan / Lenton, James / Wah, Tze Min

Cancers

2023 Volume 15, Issue 7

Abstract: There is a lack of cheap and effective biomarkers for the prediction of renal cancer outcomes post-image-guided ablation. This is a retrospective study of patients with localised small renal cell cancer (T1a or T1b) undergoing cryoablation or ... ...

Abstract	There is a lack of cheap and effective biomarkers for the prediction of renal cancer outcomes post-image-guided ablation. This is a retrospective study of patients with localised small renal cell cancer (T1a or T1b) undergoing cryoablation or radiofrequency ablation (RFA) at our institution from 2003 to 2016. A total of 203 patients were included in the analysis. In the multivariable analysis, patients with raised neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) pre-operatively, post-operatively and peri-operatively are associated with significantly worsened cancer-specific survival, overall survival and metastasis-free survival. Furthermore, an increased PLR pre-operatively is also associated with increased odds of a larger than 25% drop in renal function post-operatively. In conclusion, NLR and PLR are effective prognostic factors in predicting oncological outcomes and peri-operative outcomes; however, larger external datasets should be used to validate the findings prior to clinical application.
Language	English
Publishing date	2023-04-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15072187
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Article ; Online: Long-term outcomes of image-guided ablation and laparoscopic partial nephrectomy for T1 renal cell carcinoma.

Chan, Vinson Wai-Shun / Osman, Filzah Hanis / Cartledge, Jon / Gregory, Walter / Kimuli, Michael / Vasudev, Naveen S / Ralph, Christy / Jagdev, Satinder / Bhattarai, Selina / Smith, Jonathan / Lenton, James / Wah, Tze Min

European radiology

2022 Volume 32, Issue 9, Page(s) 5811–5820

Abstract: Objective: To compare long-term outcomes and peri-operative outcomes of image-guided ablation (IGA) and laparoscopic partial nephrectomy (LPN).: Material and methods: This is a retrospective cohort study of localised RCC (T1a/bN0M0) patients ... ...

Abstract	Objective: To compare long-term outcomes and peri-operative outcomes of image-guided ablation (IGA) and laparoscopic partial nephrectomy (LPN). Material and methods: This is a retrospective cohort study of localised RCC (T1a/bN0M0) patients undergoing cryoablation (CRYO), radio-frequency ablation (RFA), or LPN at our institution from 2003 to 2016. Oncological outcomes were compared using Cox regression and log-rank analysis. eGFR changes were compared using Kruskal-Wallis and Wilcoxon-rank tests. Results: A total of 296 (238 T1a, 58 T1b) consecutive patients were identified; 103, 100, and 93 patients underwent CRYO, RFA, and LPN, respectively. Median follow-up time was 75, 98, and 71 months, respectively. On univariate analysis, all oncological outcomes were comparable amongst CRYO, RFA, and LPN (p > 0.05). On multivariate analysis, T1a patients undergoing RFA had improved local recurrence-free survival (LRFS) (HR 0.002, 95% CI 0.00-0.11, p = 0.003) and metastasis-free survival (HR 0.002, 95% CI 0.00-0.52, p = 0.029) compared to LPN. In T1a and T1b patients combined, both CRYO (HR 0.07, 95% CI 0.01-0.73, p = 0.026) and RFA (HR 0.04, 95% CI 0.03-0.48, p = 0.011) had improved LRFS rates. Patients undergoing CRYO and RFA had a significantly smaller median decrease in eGFR post-operatively compared to LPN (T1a: p < 0.001; T1b: p = 0.047). Limitations include retrospective design and limited statistical power. Conclusions: IGA is potentially as good as LPN in oncological durability. IGA preserves kidney function significantly better than LPN. More studies with larger sample size should be performed to establish IGA as a first-line treatment alongside LPN. Key points: • Ablative therapies are alternatives to partial nephrectomy for managing small renal cell carcinomas. • This study reports long-term outcomes of image-guided ablation versus partial nephrectomy. • Ablative therapies have comparable oncological durability and better renal function preservation compared to partial nephrectomy.
MeSH term(s)	Carcinoma, Renal Cell/pathology ; Humans ; Immunoglobulin A ; Kidney Neoplasms/diagnostic imaging ; Kidney Neoplasms/surgery ; Laparoscopy ; Nephrectomy ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Immunoglobulin A
Language	English
Publishing date	2022-04-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-022-08719-1
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Article ; Online: Ureteric Injury after Image-Guided Ablation of Renal Cell Cancer with Irreversible Electroporation.

Ng, Helen / Wang, Kaiwen / Cartledge, Jon / Ralph, Christy / Jagdev, Satinder / Vasudev, Naveen / Bhattarai, Selina / Wah, Tze Min

Journal of vascular and interventional radiology : JVIR

2020 Volume 32, Issue 2, Page(s) 322–324

MeSH term(s)	Ablation Techniques/adverse effects ; Aged ; Burns, Electric/diagnostic imaging ; Burns, Electric/etiology ; Burns, Electric/therapy ; Carcinoma, Renal Cell/diagnostic imaging ; Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/surgery ; Electroporation ; Humans ; Hydronephrosis/etiology ; Kidney Neoplasms/diagnostic imaging ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Male ; Radiography, Interventional ; Stents ; Treatment Outcome ; Ureter/diagnostic imaging ; Ureter/injuries
Language	English
Publishing date	2020-12-05
Publishing country	United States
Document type	Letter
ZDB-ID	1137756-2
ISSN	1535-7732 ; 1051-0443
ISSN (online)	1535-7732
ISSN	1051-0443
DOI	10.1016/j.jvir.2020.09.015
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Article: Iatrogenic ureteric stricture post image guided renal cryoablation in a patient with von hippel-lindau syndrome.

Ng, Helen / Chan, Vinson Wai-Shun / Cartledge, Jon / Kimuli, Michael / Ralph, Christy / Jagdev, Satinder / Vasudev, Naveen / Bhattarai, Selina / Lenton, James / Smith, Jonathan / Wah, Tze Min

Radiology case reports

2021 Volume 16, Issue 8, Page(s) 2057

Abstract: A 53-year-old lady is known to have Von Hippel-Lindau syndrome with a long history of previous renal cell carcinomas (RCCs) in both kidneys. She was treated by partial nephrectomy for a right peripheral RCC and subsequently image guided radiofrequency ... ...

Abstract	A 53-year-old lady is known to have Von Hippel-Lindau syndrome with a long history of previous renal cell carcinomas (RCCs) in both kidneys. She was treated by partial nephrectomy for a right peripheral RCC and subsequently image guided radiofrequency ablation (RFA) of a left central RCC. She developed another de novo RCC adjacent to the right pelvic-ureteric junction (PUJ) 4 years after the initial RFA. Due to the close proximity to the PUJ and visibility of an ice ball with cryoablation (CRYO), the consensus from the MDT was that CRYO would be safer than RFA and she subsequently underwent percutaneous image guided CRYO to treat the small de novo RCC. Unfortunately, during the 1-month imaging follow up, she developed moderate hydronephrosis and a ureteric stricture needing long-term ureteric stent management. This case highlights the risk of ureteric injury caused by the thermal effect of the ice ball during image guided renal CRYO. Therefore, it is vital that all interventional radiologists adopt various manoeuvres to protect the ureter from the ice ball during CRYO in order to avoid the development of latent ureteric stricture.
Language	English
Publishing date	2021-06-08
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2021.05.003
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Article ; Online: Irreversible electroporation (IRE) in renal cell carcinoma (RCC): a mid-term clinical experience.

Wah, Tze Min / Lenton, James / Smith, Jonathan / Bassett, Paul / Jagdev, Satinder / Ralph, Christy / Vasudev, Naveen / Bhattarai, Selina / Kimuli, Michael / Cartledge, Jon

European radiology

2021 Volume 31, Issue 10, Page(s) 7491–7499

Abstract: Objectives: To evaluate the safety and efficacy of CT-guided IRE of clinical T1a (cT1a) renal tumours close to vital structures and to assess factors that may influence the technical success and early oncological durability.: Methods: CT-guided IRE ( ... ...

Abstract	Objectives: To evaluate the safety and efficacy of CT-guided IRE of clinical T1a (cT1a) renal tumours close to vital structures and to assess factors that may influence the technical success and early oncological durability. Methods: CT-guided IRE (2015-2020) was prospectively evaluated. Patients' demographics, technical details/success, Clavien-Dindo (CD) classification of complications (I-V) and oncological outcome were collated. Statistical analysis was performed to determine variables associated with complications. The overall 2- and 3-year cancer-specific (CS), local recurrence-free (LRF) and metastasis-free (MF) survival rates are presented using the Kaplan-Meier curves. Results: Thirty cT1a RCCs (biopsy-proven/known VHL disease) in 26 patients (age 32-81 years) were treated with IRE. The mean tumour size was 2.5 cm and the median follow-up was 37 months. The primary technical success rate was 73.3%, where 22 RCCs were completely IRE ablated. Seven residual diseases were successfully ablated with cryoablation, achieving an overall technical success rate of 97%. One patient did not have repeat treatment as he died from unexpected stroke at 4-month post-IRE. One patient had CD-III complication with a proximal ureteric injury. Five patients developed > 25% reduction of eGFR immediately post-IRE. All patients have preservation of renal function without the requirement for renal dialysis. The overall 2- and 3-year CS, LRF and MF survival rates are 89%, 96%, 91% and 87%. Conclusion: CT-guided IRE in cT1a RCC is safe with acceptable complications. The primary technical success rate was suboptimal due to the early operator's learning curve, and long-term follow-up is required to validate the IRE oncological durability. Key points: • Irreversible electroporation should only be considered when surgery or image-guided thermal ablation is not an option for small renal cancer. • This non-thermal technique is safe in the treatment of small renal cancer and the primary technical success rate was 73.3%. • This can be used when renal cancer is close to important structure.
MeSH term(s)	Ablation Techniques ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell/surgery ; Electroporation ; Humans ; Kidney Neoplasms/diagnostic imaging ; Kidney Neoplasms/surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Treatment Outcome
Language	English
Publishing date	2021-03-30
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-021-07846-5
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Article ; Online: Multimodal image-guided ablation on management of renal cancer in Von-Hippel-Lindau syndrome patients from 2004 to 2021 at a specialist centre: A longitudinal observational study.

Chan, Vinson Wai-Shun / Lenton, James / Smith, Jonathan / Jagdev, Satinder / Ralph, Christy / Vasudev, Naveen / Bhattarai, Selina / Lewington, Andrew / Kimuli, Michael / Cartledge, Jon / Wah, Tze Min

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2021 Volume 48, Issue 3, Page(s) 672–679

Abstract: Objectives: To analyse the safety, technical feasibility, long-term renal function and oncological outcome of multimodal technologies in image-guided ablation (IGA) for renal cancer in Von-Hippel-Lindau (VHL) patients, and to evaluate factors that may ... ...

Abstract	Objectives: To analyse the safety, technical feasibility, long-term renal function and oncological outcome of multimodal technologies in image-guided ablation (IGA) for renal cancer in Von-Hippel-Lindau (VHL) patients, and to evaluate factors that may influence the outcome. Methods: Retrospective analysis of a prospective database of VHL patients who underwent IGA at a specialist centre. Patient's demographics, treatment energy, peri-operative outcome and oncological outcomes were recorded. Statistical analysis was performed to determine factors associated with complication and renal function reduction. The overall, 5 and 10-year cancer specific (CS), local recurrence-free (LRF) and metastasis-free (MF) survival rates were presented with Kaplan-Meier Curves. Results: From 2004 to 2021, 17 VHL patients (age 21-68.2) with a mean (±SD) RCC size of 2.06 ± 0.92 cm received IGA. Median (IQR) RCCs per patient was 3 (2-4) over the course of follow up. Fifty-four RCCs were treated using radiofrequency ablation (n = 11), cryoablation (n = 38) and irreversible electroporation (n = 8) in 50 sessions. Primary and overall technical success rate were 94.4% (51/54) and 98% (53/54). One CD-III complication with proximal ureteric injury. Five patients in seven treatment sessions experienced a >25% reduction of eGFR immediately post-IGA. All patients have preservation of renal function at a median follow-up of 79 (51-134) months. The 5 and 10-year CS, LRF and MF survival rates are 100%, 97.8% and 100%. Whilst, the 5 and 10-year overall survival rate are100% and 90%. Conclusion: Multimodal IGA of de novo RCC for VHL patients is safe and has provided long term preservation of renal function and robust oncological durability.
MeSH term(s)	Adult ; Aged ; Carcinoma, Renal Cell/surgery ; Female ; Humans ; Immunoglobulin A ; Kidney Neoplasms/complications ; Kidney Neoplasms/surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Young Adult ; von Hippel-Lindau Disease/complications ; von Hippel-Lindau Disease/surgery
Chemical Substances	Immunoglobulin A
Language	English
Publishing date	2021-10-28
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2021.10.022
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Yolk sac tumor of the seminal vesicles: A rare malignant cause of hematospermia.

Gill, Jonathan D / Bhattarai, Selina / Patel, Chirag N / Paul, Alan B

Urology annals

2014 Volume 7, Issue 1, Page(s) 107–108

Abstract: Extra-gonadal yolk sac tumors (YSTs) are rare and generally associated with poor outcomes. Involvement of the seminal vesicles is extremely rare with only one previously described case. We report a case of a primary YST of the seminal vesicles and ... ...

Abstract	Extra-gonadal yolk sac tumors (YSTs) are rare and generally associated with poor outcomes. Involvement of the seminal vesicles is extremely rare with only one previously described case. We report a case of a primary YST of the seminal vesicles and discuss the management strategy.
Language	English
Publishing date	2014-06-10
Publishing country	India
Document type	Case Reports
ISSN	0974-7796
ISSN	0974-7796
DOI	10.4103/0974-7796.148646
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Article: Urinothorax following percutaneous image-guided renal cryoablation.

Ng, Helen / Wang, Kaiwen / Cartledge, Jon / Biyani, Chandra Shekhar / Ralph, Christy / Jagdev, Satinder / Vasudev, Naveen / Bhattarai, Selina / Bhartia, Bobby / Lenton, James / Smith, Jonathan / Whiteley, Simon / Tcherveniakov, Peter / Wah, Tze Min

Radiology case reports

2020 Volume 15, Issue 11, Page(s) 2348–2352

Abstract: A 69-year-old lady with 2 renal cell carcinomas, one sited at the upper pole of her solitary right kidney, underwent percutaneous image-guided cryoablation and developed urinothorax as a complication. This was diagnosed from pleural fluid analysis and ... ...

Abstract	A 69-year-old lady with 2 renal cell carcinomas, one sited at the upper pole of her solitary right kidney, underwent percutaneous image-guided cryoablation and developed urinothorax as a complication. This was diagnosed from pleural fluid analysis and radiology imaging with computed tomography (CT). Management included image-guided chest drain and retrograde ureteric stent insertion to divert the urine from entering the pleural cavity. CT images demonstrated a fistula between the site of renal puncture and the pleural cavity, indicating that the cryoprobes traversed the diaphragm during the procedure. This case highlights urinothorax as an unusual complication of cryoablation of renal cell carcinoma. Prompt diagnosis by interventional radiologists is crucial to avert from this potentially life-threatening complication.
Language	English
Publishing date	2020-09-15
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2020.09.013
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Article: Lymphoepithelioma-like carcinoma of the renal pelvis: Pathological and therapeutic implications.

Modi, Hemel / Beckley, Ian / Bhattarai, Selina / Spencer, John / Cartledge, Jon

Canadian Urological Association journal = Journal de l'Association des urologues du Canada

2013 Volume 7, Issue 9-10, Page(s) E590–3

Abstract: A 75-year-old woman presented with a presumed urothelial carcinoma of the right renal pelvis. A radical nephroureterectomy was carried out and histological analysis of the specimen revealed lymphoepithelioma-like carcinoma. This is the seventh reported ... ...

Abstract	A 75-year-old woman presented with a presumed urothelial carcinoma of the right renal pelvis. A radical nephroureterectomy was carried out and histological analysis of the specimen revealed lymphoepithelioma-like carcinoma. This is the seventh reported case of this normally nasopharyngeal tumour found in the renal pelvis. These tumours have a distinct histological appearance comprising sheets of undifferentiated syncytial cells on a background of lymphoid stroma. We review the pathological features of lymphoepithelioma-like carcinoma and make arguments for managing these tumours in a similar way to urothelial carcinoma.
Language	English
Publishing date	2013-08-19
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2431403-1
ISSN	1911-6470
ISSN	1911-6470
DOI	10.5489/cuaj.1545
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Article ; Online: Bacteraemia during Transurethral Resection of the Prostate: What Are the Risk Factors and Is It More Common than We Think?

Mohee, Amar Raj / Gascoyne-Binzi, Deborah / West, Robert / Bhattarai, Selina / Eardley, Ian / Sandoe, Jonathan A T

PloS one

2016 Volume 11, Issue 7, Page(s) e0157864

Abstract: The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ... ...

Abstract	The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ethically approved, prospective, cohort study of patients undergoing TURP was conducted. Clinical information and follow-up details were collected using standardized data collection sheets. Blood was obtained for culture at 6 different time points peri-procedure. Standard of care antibiotic prophylaxis was given prior to surgery. Bacteriuria was assessed in a pre-procedure urine sample. Histopathology from all prostate chips was assessed for inflammation and malignancy. 73 patients were consented and 276 blood samples obtained. No patients developed symptomatic bacteraemia during the procedure, 17 patients developed asymptomatic bacteraemia (23.2%). Enterococcus faecalis and Pseudomonas aeruginosa were the most common organisms cultured. 10 minutes after the start of the TURP, the odds ratio (OR) of developing bacteraemia was 5.38 (CI 0.97-29.87 p = 0.05), and 20 minutes after the start of the procedure, the OR was 6.46 (CI 1.12-37.24, p = 0.03), compared to before the procedure. We also found an association between the development of intra-operative bacteraemia and recent antibiotic use (OR 4.34, CI 1.14-16.62, p = 0.032), the presence of a urinary catheter (OR 4.92, CI 1.13-21.51, p = 0.034) and a malignant histology (OR 4.90, CI 1.30-18.46, p = 0.019). There was no statistical relationship between pre-operative urine culture results and blood culture results. This study shows that asymptomatic bacteraemia is commonly caused by TURP and occurs in spite of antibiotic prophylaxis. Our findings challenge the commonly held view that urine is the primary source of bacteraemia in TURP-associated sepsis and raise the possibility of occult prostatic infection as a cause of bacteraemia. More work will be needed to determine the significance of transient bacteraemia in relation to more serious complications like infective endocarditis and malignancy.
MeSH term(s)	Aged ; Bacteremia/drug therapy ; Case-Control Studies ; Endocarditis/complications ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Odds Ratio ; Prospective Studies ; Prostate/surgery ; Prostatic Hyperplasia/complications ; Prostatic Hyperplasia/surgery ; Risk Factors ; Sepsis/complications ; Transurethral Resection of Prostate/adverse effects
Language	English
Publishing date	2016-07-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0157864
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