Magnus Annerstedt

University of Copenhagen Herlev Hospital, Herlev, Capital Region, Denmark

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Publications (4)24.96 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes. A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference. A systematic review of the literature was performed in agreement with the PRISMA statement. Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques. RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference. Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 01/2015; 67(3). · 12.48 Impact Factor
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    ABSTRACT: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity. To report a systematic literature review and cumulative analysis of perioperative outcomes and complications of RARC in comparison with ORC and LRC. Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. Cumulative analysis was conducted. The searches retrieved 105 papers. According to the different diversion type, overall mean operative time ranged from 360 to 420min. Similarly, mean blood loss ranged from 260 to 480ml. Mean in-hospital stay was about 9 d for all diversion types, with consistently high readmission rates. In series reporting on RARC with either extracorporeal or intracorporeal conduit diversion, overall 90-d complication rates were 59% (high-grade complication: 15%). In series reporting RARC with intracorporeal continent diversion, the overall 30-d complication rate was 45.7% (high-grade complication: 28%). Reported mortality rates were ≤3% for all diversion types. Comparing RARC and ORC, cumulative analyses demonstrated shorter operative time for ORC, whereas blood loss and in-hospital stay were better with RARC (all p values <0.003). Moreover, 90-d complication rates of any-grade and 90-d grade 3 complication rates were lower for RARC (all p values <0.04), whereas high-grade complication and mortality rates were similar. RARC can be performed safely with acceptable perioperative outcome, although complications are common. Cumulative analyses demonstrated that operative time was shorter with ORC, whereas RARC may provide some advantages in terms of blood loss and transfusion rates and, more limitedly, for postoperative complication rates over ORC and LRC. Although open radical cystectomy (RC) is still regarded as a standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RC are becoming more popular. Robotic RC can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications; however, as for open RC, the risk of postoperative complications is high, including a substantial risk of major complication and reoperation. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 01/2015; · 12.48 Impact Factor
  • Magnus Annerstedt, Alex Mottrie
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    ABSTRACT: Pelvic lymph node dissection (PLND) is primarily a staging procedure most commonly used in prostate and bladder cancer. The role of lymphadenectomy has been well studied in patients with other types of malignancies and there is a consensus that the accuracy of the staging improves as more nodes are removed. The rationale for a staging PLND in prostate cancer is to accurately detect micrometastases in order to judge the need for adjuvant therapy. Currently, there is no consensus in the literature when considering the anatomical extent of the PLND. Several studies have shown that an extended PLND detects about twice as many nodes compared to a limited, restricted to the obturator fossa, dissection. PLND can be omitted in patients with low risk disease (Gleason score 6 or less, PSA greaterthan 10 ng/ml, cT1c) where the risk of having positive lymph node is less than 10%. For patients with greater risk of having metastasis we recommend an extended pelvic lymph node dissection (ePLND) which includes the nodes along the obturator fossa, the internal, external and common iliac arteries up to the crossing of the ureter. In bladder cancer the presence of lymph node metastases is on of the most important predictors of patient outcomes. There is evidence that a meticulous PLND at the time of radical cystectomy also can be curative in locally advanced disease. The advantages of robotic surgery (ten times magnification, EndoWrist© dexterity, 3-D view etc.) have allowed a transition from open to minimally invasive surgery, preserving the classical surgical technique. The most frequent complications related to PLND are lymphocele and lymph edema due to disruption of lymphatic vessels. Venous thrombotic events (VTE) and pulmonary embolism (PE) are potential complications associated with PLND. KeywordsProstate cancer-Bladder cancer-Pelvic lymph node dissection-Robotic prostatectomy-Robotic cystectomy
    12/2011: pages 391-396;
  • Magnus Annerstedt, Peter Wiklund
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    ABSTRACT: Radical cystectomy with pelvic lymph node dissection is the gold standard for treatment of localized invasive bladder cancer.1 - 3 The procedure is associated with a substantial morbidity and 25–50% of the patients will have complications in the perioperative period.4 - 6 The first laparoscopic cystectomy was performed in 19927 and several other centers have followed.8 Laparoscopic cystectomy has been reported in more than 500 patients and current results indicate that this minimally invasive approach may cause less blood loss, decreased postoperative pain, and faster recovery compared to open surgery.9,10 Due to the technical challenges of conventional laparoscopy (counterintuitive motion, two-dimensional laparoscopic vision, ergonomic drawback, and non-flexible instruments), leading to a steep learning curve and the lack of long-term oncological results, this approach has not gained a wide acceptance among urologists. KeywordsBladder cancer-Intracorporeal urinary diversion-Robotic cystectomy
    12/2011: pages 369-380;