Astaxanthin (ASX) is a marine-based ketocarotenoid; an accessory pigment in plants in that it has many different potential functions. ASX is an antioxidant that is notably more potent than many other antioxidants. Antioxidants have anti-inflammatory and oxidative stress-reducing properties to potentially reduce the incidence of cancer or inhibit the expansion of tumor cells. In this study, we tested the hypothesis that ASX would inhibit proliferation and migration of breast cancer cells in vitro. We found that application of ASX significantly reduced proliferation rates and inhibited breast cancer cell migration compared to control normal breast epithelial cells. Based on these results, further investigation of the effects of ASX on not only breast cancer cells, but other forms of tumor cells, should be carried out.

Radiation therapy has increasingly been used in the management of pelvic malignancies. However, the use of radiation continues to pose a risk of a secondary malignancy to its recipients. This study investigates the risk of secondary malignancy development following radiation for primary pelvic malignancies. A retrospective cohort review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016 was performed. Primary pelvic malignancies were subdivided based on the receipt of radiation, and secondary malignancies were stratified as pelvic or nonpelvic to investigate the local effect of radiation. A total of 2 102 192 patients were analyzed (1 189 108 with prostate, 315 026 with bladder, 88 809 with cervical, 249 535 with uterine, and 259 714 with rectal/anal cancer). The incidence rate (defined as cases per 1000 person years) of any secondary malignancies (including but not limited to secondary pelvic malignancies) was higher in radiation patients than in nonradiation patients (incidence rate ratio [IRR] 1.04, confidence interval [CI] 1.03-1.05), with significantly greater rates noted in radiation patients with prostate (IRR 1.22, CI 1.21-1.24), uterine (IRR 1.34), and cervical (IRR 1.80, CI 1.72-1.88) cancer. While the overall incidence rate of any secondary pelvic malignancy was lower in radiation patients (IRR 0.79, CI 0.78-0.81), a greater incidence was still noted in the same cohorts including radiation patients with prostate (IRR 1.42, CI 1.39-1.45), uterine (IRR 1.15, CI 1.08-1.21), and cervical (IRR 1.72, CI 1.59-1.86) cancer. Except for localized cervical cancer, when put in the context of median overall survival, the impact of radiation likely does not carry enough weight to change practice patterns. Radiation for pelvic malignancies increases the risk for several secondary malignancies, and more specifically, secondary pelvic malignancies, but with a relatively low absolute risk of secondary malignancies, the benefits of radiation warrant continued use for most pelvic malignancies. Practice changes should be considered for radiation utilization in malignancies with excellent cancer-specific survival such as cervical cancer. The use of radiation for the management of pelvic malignancies induces a risk of secondary malignancies to its recipients. However, the absolute risk being low, the benefits of radiation warrant its continued use, and a change in practice patterns is unlikely.

Clinical History: Endoscopic management of extensive isolated tumor burden within a bladder diverticulum is technically difficult. Physical Exam: The patient presented with gross hematuria. Diagnosis: We describe the case of a 70-year-old male with history of high-grade T1 nonmuscle invasive bladder cancer who was referred for management of extensive tumor burden found within a left lateral wall bladder diverticulum. Intervention: We describe our approach for robotic partial cystectomy via a transvesical approach for management of tumor burden within a bladder diverticulum. After a vertical cystotomy was made along the midline at the dome of the bladder, the left lateral wall diverticulum was identified. Electrocautery was used to circumferentially incise the bladder diverticulum until perivesical fat was encountered. The opening of the bladder diverticulum was closed with braided absorbable suture to reduce the risk of tumor spillage. Once the diverticulum was dissected free off the perivesical fat, the bladder defect was closed in two layers using braided absorbable suture. The cystotomy was closed in a two-layer running fashion and was confirmed to be water-tight. Follow-Up/Outcomes: Operative time was 91 minutes and estimated blood loss was 25 mL. There were no intraoperative complications, and the patient was discharged on the same day with a Foley catheter in place. Postoperative pathology demonstrated high-grade Ta nonmuscle invasive bladder cancer. The patient had a successful trial of void 2 weeks postoperatively and has not experienced any postoperative complications. Robotic partial cystectomy via a transvesical approach may be utilized for management of tumor burden within a bladder diverticulum. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The study was approved by the institutional review board at Temple University (protocol number 20793). M.L., C.M., and J.J. have no conflicts of interest to disclose. D.E. is founder of Melzi corp and a consultant for Intuitive Surgical and Johnson and Johnson: . Runtime of video: 4 mins 15 secs

We received the critique of our article ¹ Woodward S.G. Rios-Diaz A.J. Zheng R. et al. Finding the most favorable timing for cholecystectomy after percutaneous cholecystostomy tube placement: an analysis of institutional and national data. J Am Coll Surg. 2021; 232 : 55-64 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar from Sakamoto and Lefor and appreciate the feedback. In their letter to the editor, Sakamoto and Lefor identified 3 main points of clarification within our article, with the first questioning the exclusion of patients undergoing cholecystectomy within the same admission of percutaneous cholecystostomy tube (PCT) placement, the second point addressing patients with retained common bile duct stones postoperatively as it relates to PCT timing, and finally, using a linear assumption in analyzing the relationship between surgical complications and duration of PCT. We would like to address these points.

Objective: Radical cystectomy with urinary diversion is the standard of care for management of muscle invasive bladder cancer. In appropriately selected patients, orthotopic neobladder formation may offer benefits including preserved body image and continence. We describe our approach to robotic intracorporeal orthotopic neobladder formation. Patients and surgical procedure We report the case of a 60-year-old male with high grade T2a muscle invasive bladder cancer who underwent robotic radical cystectomy with intracorporeal orthotopic neobladder formation. Robotic ports are placed 6 cm more cephalad than the standard prostatectomy configuration and the left lateral 12 mm robotic fourth arm is placed one handbreadth toward the anterior superior iliac spine for optimal operability of the robotic stapler. Following standard radical cystectomy and bilateral pelvic lymph node dissection, we construct the neobladder by forming a W-shaped configuration of ileum with two troughs anchored to the foley catheter. The anti-mesenteric side of the ileum is detubularized and a posterior ileal plate is formed by suturing the cut edges of the anti-mesenteric borders. A circumferential ileo-urethral anastomosis is completed, and the anterior ileal plate is formed by suturing together the lateral most cut edges of the anti-mesenteric borders. Ureteral stents are placed and the ileal neobladder is removed from continuity using a robotic stapler. Uretero-enteric anastomoses are completed over the ureteral stents and intravenous indocyanine green is visualized under near infrared fluorescence to assess for vascularization of the anastomosis. Results: Total operative time was 500 min with estimated blood loss of 300 mL. There were no intraoperative complications, and the patient was discharged on postoperative day 5 after an uncomplicated hospitalization. The patient's foley and ureteral stents were removed on postoperative day 14. At 12-months follow-up, there were no major (Clavien > 2) postoperative complications. Conclusions: Robotic intracorporeal orthotopic neobladder formation can be an effective technique for urinary diversion in patients with muscle invasive bladder cancer.

We present a 60-year-old female with a history of interstitial cystitis who underwent simple cystectomy with orthotopic neobladder creation. Her postoperative course was complicated by a neovesicoc...