Alan McNeill

NHS Lothian, Edinburgh, Scotland, United Kingdom

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Publications (28)74.58 Total impact

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    ABSTRACT: The aim of this study was to investigate the effect of VEGF targeted therapy (sunitinib) on molecular intratumoral heterogeneity (ITH) in metastatic clear cell renal cancer (mccRCC). Multiple tumor samples (n=187 samples) were taken from the primary renal tumors of mccRCC patients who were sunitinib treated (n=23, SuMR clinical trial) or untreated (n=23, SCOTRRCC study). ITH of pathological grade, DNA (aCGH), mRNA (Illumina Beadarray) and candidate proteins (reverse phase protein array) were evaluated using unsupervised and supervised analyses (driver mutations, hypoxia and stromal related genes). ITH was analysed using intratumoral protein variance distributions and distribution of individual patient aCGH and gene expression clustering. Tumor grade heterogeneity was greater in treated compared to untreated tumors (P=0.002). In unsupervised analysis, sunitinib therapy was not associated with increased ITH in DNA or mRNA. However, there was an increase in ITH for the driver mutation gene signature (DNA and mRNA) as well as increasing variability of protein expression with treatment (p<0.05). Despite this variability, significant chromosomal and transcript changes to key targets of sunitinib, such as VHL, PBRM1 and CAIX, occurred in the treated samples. These findings suggest that sunitinib treatment has significant effects on the expression and ITH of key tumor and treatment specific genes/proteins in mccRCC. The results, based on primary tumor analysis, do not support the hypothesis that resistant clones are selected and predominate following targeted therapy. Copyright © 2015, American Association for Cancer Research.
    Clinical Cancer Research 05/2015; 21(18). DOI:10.1158/1078-0432.CCR-15-0207 · 8.72 Impact Factor

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    ABSTRACT: To systematically review the range of methods available for assessing elasticity in the prostate and to examine its use as a biomarker for prostate cancer. A systematic review of the electronic database PubMed was performed up to December 2012. All relevant studies assessing the use of elasticity as a biomarker for prostate cancer were included except those not studying human prostates or reporting a sensitivity, specificity or quantitative elasticity value. There has been much interest in the use of elasticity in the detection of prostate cancer and there have been many publications using various methods of detection. The most common method of assessment is an imaging method, called sonoelastography. Further imaging methods include ultrasound (US), three-dimensional US and magnetic resonance elastography. These methods are reviewed for sensitivity and specificity. The other method of assessment is the mechanical method. These use quantitative elasticity values to differentiate benign from malignant areas of the prostate. This method of assessment has shown that the elasticity changes for differing Gleason grades and T stages of disease within the prostate. Quantitative elasticity values offer the potential of using 'threshold' elasticity values under which the prostate is benign. Tissue elasticity has great potential as a diagnostic and prognostic biomarker for prostate cancer and can be assessed using various methods. Currently transrectal sonoelastography has the most evidence supporting its use in clinical practice.
    BJU International 05/2013; 113(4). DOI:10.1111/bju.12236 · 3.53 Impact Factor
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    ABSTRACT: Purpose: To determine the stage-specific operative, postoperative and oncologic outcomes, for patients undergoing a laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) in a single center and assess changes over a generation of practice. Patients and methods: From December 1992 to July 2011, data were collected prospectively for 854 consecutive simple laparoscopic necphrectomies (LNs) and LRNs, 397 of which were LRNs for RCC. The first LRN was performed in December 1997. Stage-specific surgical and oncologic outcomes were assessed across the study period. Patients were then grouped into three equal consecutive cohorts. Case mix and surgical outcomes were compared to assess changes with departmental experience. Results: There were 206, 71, 118, and 2 patients across stages pT1, pT2, pT3, and pT4, respectively. Median operative time was significantly shorter for pT1 tumors (125, 150 and 150 min for pT1-3, P<0.021), while median estimated blood loss (EBL) was greater for pT3 tumors (50, 50, 100 mL, for pT1-3, P<0.001). Median follow-up time was 31, 30, and 18 months, respectively, across pT1-pT3. There was a significant difference in 5-year overall survival (82.4%, 68.4%, 58.9%), cancer-specific survival (99.5%, 83.6%, 66.5%) and progression free survival (86.5%, 66.3%, 47.5%) across these stage-specific subgroups. Over the three cohorts, there was an increase in LRN performed for locally advanced disease and cytoreduction. With greater surgical experience, there was improvement in median operative time and median EBL in localized disease over the three periods, but no significant changes for locally advanced disease. Conclusion: This is the largest reported series of LRN in the United Kingdom. Departmental experience has resulted in improved surgical outcomes for localized RCC, with expansion of practice in more complex advanced disease. Laparoscopic nephrectomy is both operatively and oncologically safe in T1 and T2 disease, and although technically more demanding, it is also safe in selected T3 disease.
    Journal of endourology / Endourological Society 05/2013; 27(8). DOI:10.1089/end.2012.0562 · 1.71 Impact Factor
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    ABSTRACT: Develop a device to measure & quantify prostate stiffness in vivo, that can be deployed during a digital rectal examination (DRE) to assess tissue quality & also be used for guided dissections.
    3rd International Conference on Oncological Engineering; 01/2013
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    ABSTRACT: Develop a device to measure & quantify prostate stiffness in vivo, that can be deployed during a digital rectal examination (DRE) to assess tissue quality & also be used for guided dissections.
    3rd International Conference on Oncological Engineering; 01/2013
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    International Journal of Surgery 12/2012; 10(8). DOI:10.1016/j.ijsu.2012.06.017 · 1.53 Impact Factor
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    ABSTRACT: Objectives: Urologists are cautious to offer minimally invasive radical prostatectomy in prostate cancer patients with high prostate-specific antigen (and therefore anticipated to have locally advanced or metastatic disease) because of concerns regarding lack of complete cure after minimally invasive radical prostatectomy and of worsening of continence if adjuvant radiotherapy is used. Methods: A retrospective review of our institutional database was carried out to identify patients with PSA ≥20 ng/mL who underwent minimally invasive radical prostatectomy between January 2002 and October 2010. Intraoperative, pathological, functional and short-term oncological outcomes were assessed. Results: Overall, 233 patients met study criteria and were included in the analysis. The median prostate-specific antigen and prostate size were 28.5 ng/mL and 47 mL, respectively. Intraoperative complications were the following: rectal injury (0.86%) and blood transfusion (1.7%). Early postoperative complications included prolonged (>6 days) catheterization (9.4%), hematoma (4.7%), deep venous thrombosis (0.86%) and lymphocele (5.1%). Late postoperative complications included cerebrovascular accident (0.4%) and anastomotic stricture (0.8%). Pathology revealed poorly differentiated cancer in 48.9%, pT3/pT4 disease in 55.8%, positive margins in 28.3% and lymph node disease in 20.2% of the cases. Adverse pathological findings were more frequent in patients with prostate-specific antigen >40 ng/mL and (or) in those with locally advanced disease (pT3/pT4). In 62.2% of the cases, adjuvant radiotherapy was used. At 1-year follow up, 80% of patients did not show evidence of biochemical recurrence and 98.8% of them had good recovery of continence. Conclusion: Minimally invasive radical prostatectomy might represent a reasonable option in prostate cancer patients with high prostate-specific antigen as a part of a multimodality treatment approach.
    International Journal of Urology 07/2012; 19(10):923-7. DOI:10.1111/j.1442-2042.2012.03068.x · 2.41 Impact Factor
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    ABSTRACT: Introduction Laparoscopic nephrectomy (LN) has largely replaced open nephrectomy. The aim of this study was to describe a validated modular system for training urologists in LN in the context of the shorter training times available in the current era. Methods Following attendance at dry and wet lab courses, three mentees (trainee, new consultant and an experienced open surgeon) were mentored through a five module LN training system in our centre followed by the mentee's own hospital. A minimum of 25 independent procedures were then performed by mentees in their own hospital. Results 17-32 mentored cases were required to become competent in LN, followed by up to 5 observed cases in the mentee's own centre. Subsequently, data from the first 105 cases (80 LN and 25 laparoscopic nephroureterectomies (LNU)) performed by the 3 surgeons after the end of their training without observation by their mentor, were retrospectively collected and analyzed. There were 3 conversions (2.9%). For LN and LNU respectively: median operative time was 140mins (65-390mins) and 180mins (90-300mins); median estimated blood loss 30ml (0-2000ml) and 50ml (0-2000ml); median post-operative stay 4d (2-45d) and 6d (3-27d). Four patients (3.8%) required a post-operative transfusion. There was no 30-day mortality. Conclusion Mentees matched the median British Association for Urological Surgeons (BAUS) registry operating time (LN-120-180mins, LNU-180-240mins) and had lower conversion rates (2.9%vs6.4% for BAUS). Mentees matched median BAUS database reported blood loss (LN and LNU-<500ml) and LOS (LN-4d, LNU-5d). This modular training programme allows urologists to become independent in LN after a short period of focused training in the training centre followed by a short period of mentoring in the mentee's own centre.
    Journal of endourology / Endourological Society 05/2012; 26(11). DOI:10.1089/end.2012.0096 · 1.71 Impact Factor
  • Alan McNeill · Grant D Stewart ·

    BMJ (online) 11/2011; 343(nov08 1):d7215. DOI:10.1136/bmj.d7215 · 17.45 Impact Factor
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    ABSTRACT: Current management options for low-stage malignant germ-cell testicular tumours after radical orchiectomy include surveillance, chemotherapy, or retroperitoneal lymph node dissection (RPLND). Open RPLND is the surgical gold standard but has a number of limitations. Firstly, approximately two-thirds of patients have either necrosis/fibrosis or pathologically negative nodes. Secondly, the operation results in a large scar and significant perioperative morbidity and convalescence. Laparoscopic retroperitoneal lymph node dissection has developed as a possible alternative to the open procedure. Currently, laparoscopic retroperitoneal lymph node dissection (L-RPLND) is not recommended as a standard therapeutic option in the European Association of Urology (EAU) guidelines. L-RPLND has, however, proved to be an excellent staging tool ,which should be developed as a less invasive alternative to primary open RPLND. As a staging tool, L-RPLND is performed usually without retrocaval or retroaortic dissection and is used to determine pathological status. The therapeutic value of this more limited dissection is not known and currently trials are underway to establish the therapeutic benefits. L-RPLND has been reported as efficacious compared to open RPLND for staging of the retroperitoneum in patients with stage I nonseminomatous germ-cell testis tumours (NSGCT). The rate of tumour control after L-RPLND and the diagnostic accuracy of L-RPLND were equal to the open procedure, and the morbidity was significantly lower [1, 2]. Therefore, L-RPLND for stage I and low-volume retroperitoneal stage II disease may be performed at experienced urology centres as part of ongoing trials [3, 4]. Loss of antegrade ejaculation is the most common long-term problem that the young men who undergo this operation experience. In an attempt to minimise this problem, either a template dissection or nerve-sparing RPLND should be performed. In a right template dissection, the right postganglionic fibres are resected whilst the left side ones are left intact. This applies to the left side also. Complete unilateral resection of the nerves should not result in loss of antegrade ejaculation. Dissection of both sides is only required in bilateral RPLND.
    Laparoscopic and Robot-Assisted Surgery in Urology, 05/2011: pages 169-185;
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    ABSTRACT: Objective: We report a tertiary referral centre's experience of cytoreductive nephrectomy (CN) combined with immunotherapy as part of multimodality treatment for metastatic renal cell cancer (mRCC) over a period of 8 years. Patients and methods: Patients who underwent CN as part of multimodality treatment for mRCC were identified from our nephrectomy database. Demographic characteristics, oncological outcome, reasons for failure to start or to complete immunotherapy, pathological findings and a comparison between open and laparoscopic CN were evaluated. Results: Forty patients underwent CN for mRCC preceding immunotherapy. 26 (65%) failed to receive immunotherapy. This was most commonly due to poor performance status postoperatively (12/26, 46%). 14 patients (35%) received immunotherapy following surgery and 9 (23%) patients completed treatment. Laparoscopic CN was associated with a significantly lower blood loss, shorter hospital stay and lower rate of transfusion than the open approach. Conclusion: Patients are at significant risk of failure to proceed to adjuvant immunotherapy following CN for mRCC, most commonly due to poor performance status postoperatively. Laparoscopic CN is shown to be safe and effective in well-selected patients. As new targeted treatments for mRCC emerge and their use in combination with CN is evaluated, a detailed and multidisciplinary approach to selection of these patients will continue to be crucial.
    British Journal of Medical and Surgical Urology 05/2011; 4(3):101-107. DOI:10.1016/j.bjmsu.2010.08.001

  • The Journal of Urology 04/2011; 185(4). DOI:10.1016/j.juro.2011.02.1595 · 4.47 Impact Factor
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    ABSTRACT: Our purpose was to review current practice regarding the use of prostate biopsies in men older than 75 years with raised PSA by presenting the results of a retrospective audit and to identify these older men who really benefit from prostate biopsies. A high-volume tertiary center's prospectively maintained prostate biopsy database of contemporary biopsies was reviewed. Men were stratified by age and PSA. Logistic regression analysis, Mantel-Haenszel and Fisher's exact tests were used for statistical analysis. Overall, 1,593 men underwent prostate biopsies between April 2004 and August 2006. Of these, 293 patients (18.4%) with a mean age of 82.62 years and mean PSA of 30.37 ng/ml were eligible for the study with an overall incidence of prostate cancer of 73.7%. Elderly men with PSA >20 ng/ml had a prostate cancer detection rate of 91%. They were more likely to have-high grade disease (OR = 5.4, 95% CI = 2.8-10.8, p < 0.0001) and receive hormone deprivation therapy (RR = 3.0, 95% CI = 2.1-4.3, p < 0.0001). Elderly men with PSA <20 ng/ml had a 3-fold risk of being placed on active monitoring. Almost 20% of them had 1 complication following biopsy, of whom 12 (4.1%) needed hospitalization. Given the high probability of detecting prostate cancer and receiving conservative treatment, prostate biopsies can be omitted in men >75 years with PSA >20 ng/ml. However, they are still useful in fit men >75 and <80 years with PSA <20 ng/ml who can be the potential candidates for treatment with curative intent.
    Urologia Internationalis 10/2010; 85(4):410-4. DOI:10.1159/000320378 · 1.43 Impact Factor
  • E. Ong · N. Gregor · J. Hanley · C. Graham · A. McNeill · A. Riddick ·

    Urology 10/2009; 74(4). DOI:10.1016/j.urology.2009.07.083 · 2.19 Impact Factor
  • E. Ong · A. MacKay · P. Mariappan · S. Kour · A. McNeill · G. Smith ·

    Urology 10/2009; 74(4). DOI:10.1016/j.urology.2009.07.766 · 2.19 Impact Factor
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    ABSTRACT: Emphysematous pyelonephritis is a severe life-threatening infection which continues to carry significant morbidity and mortality. We present a case recently managed at our institution by laparoscopic nephrectomy. The patient survived, and in comparison to some of the more conventionally managed patients in the literature, made an extremely speedy recovery. We would advocate this option to be seriously considered when patients are suitable and appropriately trained surgeons are available.
    British Journal of Medical and Surgical Urology 09/2009; 2(5):204-207. DOI:10.1016/j.bjmsu.2009.05.004

  • European Urology Supplements 09/2009; 8(8):616-617. DOI:10.1016/S1569-9056(09)74911-5 · 3.37 Impact Factor
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    ABSTRACT: In our series of 1,900 endoscopic extraperitoneal radical prostatectomies (EERPE) the incidence of symptomatic lymphocele following simultaneous pelvic lymph node dissection (PLND) is between 3 and 14% depending on the extent of lymph node dissection. We report the impact of bilateral peritoneal fenestration after completion of extraperitoneal prostatectomy and PLND on the incidence of lymphocele, postoperative pain and complications. A total of 100 consecutive patients undergoing EERPE and extended PLND were allocated into two groups. In Group A (n = 50) a 4-6 cm incision was performed bilaterally over the external iliac vessels down to the obturator fossa after completion of the main procedure. In Group B (n = 50) no peritoneal incisions were made. The postoperative assessment protocol included a visual analogue pain scale administered three times daily for 6 days, analgesia requirement, and ultrasound examination on 4th and 8th days, and 3 months postoperatively. CRP and leucocyte counts were measured on 1st and 2nd postoperative days. Complications were recorded according to our standard protocol using the Clavien classification. Three patients (6%) in Group A were found to have lymphoceles, none of which were symptomatic. Significantly more patients in Group B developed a lymphocele, (n = 16, 32%, P < 0.001) of which a significant number were symptomatic (n = 7, 14%, P < 0.001) and required laparoscopic fenestration. No significant difference was observed between the pain score in either group. Mean pain scores were 3.4 versus 3.8 at 6 h, and 0.8 versus 1.1 at 6 days, respectively. No difference in analgesia requirement, serum inflammatory markers and return to normal bowel activity was observed between the groups. This study demonstrates that peritoneal fenestration significantly reduces the incidence of both symptomatic and asymptomatic lymphocele, without an increase in postoperative morbidity. As symptomatic lymphocele is one of the most common complications of extraperitoneal PLND requiring reintervention, we recommend that peritoneal fenestration should be performed routinely after extraperitoneal radical prostatectomy and PLND.
    World Journal of Urology 09/2008; 26(6):581-6. DOI:10.1007/s00345-008-0327-3 · 2.67 Impact Factor
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    BJU International 05/2008; 101(7):909-28. DOI:10.1111/j.1464-410X.2008.07544.x · 3.53 Impact Factor

Publication Stats

156 Citations
74.58 Total Impact Points


  • 2015
    • NHS Lothian
      Edinburgh, Scotland, United Kingdom
  • 2013
    • The University of Edinburgh
      Edinburgh, Scotland, United Kingdom
  • 2012
    • University of Patras
      • Department of Urology
      Rhion, West Greece, Greece
  • 2011
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2004-2011
    • Western General Hospital
      Edinburgh, Scotland, United Kingdom
  • 2009
    • Al-Azhar University
      Al Qāhirah, Muḩāfaz̧at al Qāhirah, Egypt
  • 2008
    • University of Leipzig
      • Institute of Pathology
      Leipzig, Saxony, Germany