Approaches to nephron-sparing surgeries (NSS) of renal lesions include partial nephrectomy (PN) and tumor enucleation (TE). Our objective was to examine the pathology of the pseudocapsule and status of the surgical margin in small renal masses treated by NSS and to correlate these findings with the surgical and oncological outcomes. All consecutive renal TE and PN specimens obtained during the period between January 2012 and December 2014, of which clinical follow-up was available, were included in this study. Pathologic features and clinical data were reviewed and analyzed. A total of 117 NSS specimens (59 EN, 58 PN) were reviewed. Clear cell renal cell carcinomas and paraganglioma had the thickest pseudocapsules (0.36 mm), while angiomyolipomas did not form a well-defined pseudocapsule. Other tumors were intermediate in their characteristics. The positive margin rate for TE and PN was 17.2 and 0 %, respectively. Compared to PN, TE involved a significantly shorter procedure time, less blood loss, and fewer post-operative complications. None of the patients from either group was found to have a local recurrence after follow-up imaging. Although positive surgical margins were more frequently seen in TE specimens, local tumor recurrence was comparable to PN. Thus, TE is a reasonable choice for pT1 renal tumors, especially for those without a prominent infiltrative growth pattern.

KEY OF DEFINITIONS FOR ABBREVIATIONS:Renal tumor enucleation allows for maximal parenchymal preservation. Identifying pseudocapsule integrity is critically important in nephron sparing surgery by enucleation. Tumor invasion into and through capsule may have clinical implications although it is not routinely commented on in standard pathologic reporting. We sought to describe a system to standardize the varying degrees of pseudocapsule invasion and to identify predictors of invasion. Materials and Methods:A multicenter retrospective review was carried out between

ImportanceThe time interval between COVID-19 infection and surgery is a potentially modifiable but understudied risk factor for postoperative complications.ObjectiveTo examine the association between time to surgery after COVID-19 diagnosis and the risk of a composite of major postoperative cardiovascular morbidity events within 30 days of surgery.Design, Setting, and ParticipantsThis single-center, retrospective cohort study was conducted among 3997 adult patients (aged ≥18 years) with a previous diagnosis of COVID-19, as documented by a positive polymerase chain reaction test result, who were undergoing surgery from January 1, 2020, to December 6, 2021. Data were obtained through Structured Query Language access of an existing perioperative data warehouse. Statistical analysis was performed March 29, 2022.ExposureThe time interval between COVID-19 diagnosis and surgery.Main Outcomes and MeasuresThe primary outcome was the composite occurrence of major cardiovascular comorbidity, defined as deep vein thrombosis, pulmonary embolism, cerebrovascular accident, myocardial injury, acute kidney injury, and death within 30 days after surgery, using multivariable logistic regression.ResultsA total of 3997 patients (2223 [55.6%]; median age, 51.3 years [IQR, 35.1-64.4 years]; 667 [16.7%] African American or Black; 2990 [74.8%] White; and 340 [8.5%] other race) were included in the study. The median time from COVID-19 diagnosis to surgery was 98 days (IQR, 30-225 days). Major postoperative adverse cardiovascular events were identified in 485 patients (12.1%). Increased time from COVID-19 diagnosis to surgery was associated with a decreased rate of the composite outcome (adjusted odds ratio, 0.99 [per 10 days]; 95% CI, 0.98-1.00; P = .006). This trend persisted for the 1552 patients who had received at least 1 dose of COVID-19 vaccine (adjusted odds ratio, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = .04).Conclusions and RelevanceThis study suggests that increased time from COVID-19 diagnosis to surgery was associated with a decreased odds of experiencing major postoperative cardiovascular morbidity. This information should be used to better inform risk-benefit discussions concerning optimal surgical timing and perioperative outcomes for patients with a history of COVID-19 infection.

Small renal tumors are usually enwrapped in a pseudocapsule with well-confined borders, a feature that facilitates the performance of nephron-sparing surgeries (NSS). Our study was designed to evaluate the histologic features of the pseudocapsule of small renal tumors. One hundred seventy-eight renal tumors (≤4 cm), which were surgically removed by total nephrectomy, partial nephrectomy, or enucleation procedures during 2002-2013, were re-examined microscopically. Special attention was paid to the completeness and thickness of the pseudocapsule as well as the extra-pseudocapsular extension (EPE); components of the pseudocapsule and the intra-pseudocapsular vasculature (size/number) were evaluated. The data were analyzed according to the histological tumor types, Fuhrman grades, and sizes. Student's t test and chi-square tests were used for statistical analysis. Among 178 renal tumors, clear cell renal carcinomas (RCC) showed the thickest pseudocapsule (average 0.23 mm), while oncocytoma showed the thinnest (average thickness of 0.09 mm). Chromophobe RCC had the highest rate of EPE and the highest percentage of tumors with larger (≥0.2 mm) intra-pseudocapsular arteries. The EPE rate was also related to the nuclear grade (p = 0.001). Muscular differentiation, reticulin, and collagen components were present in the fibrous stroma of the pseudocapsule. Our study suggests that clear cell RCC has the thickest pseudocapsule while oncocytoma has a poorly developed pseudocapsule, but shows the least infiltrative pattern. In small RCC (≤4.0 cm), the EPE rate is related to tumor grade but not to tumor size. Larger arterioles (≥0.2 mm) are encountered infrequently within the tumor pseudocapsule, with the highest percentage being found in chromophobe RCC and the lowest in papillary RCC.

Background: This study reviews and appraises the articles published about anesthesiology education in 2019. Through this critical appraisal, those interested in anesthesiology education are able to quickly review literature published during this year and explore innovative ways to improve education for all those involved in the practice of anesthesiology.Methods: Three Ovid MEDLINE databases, Embase.com, ERIC, and PsycINFO were searched followed by a manual review of articles published in the highest impact factor journals in both the fields of anesthesiology and medical education. Abstracts were double-screened and quantitative articles were subsequently scored by 3 randomly assigned raters. Qualitative studies were scored by 2 raters. Two different rubrics were used for scoring quantitative and qualitative studies; both allowed for scores ranging from 1 to 25. In addition, reviewers rated each article on its overall quality to create an additional list of top articles based solely on the opinion of the reviewers.Results: A total of 2374 unique citations were identified through the search criteria and the manual review. Of those, 70 articles met the inclusion criteria (62 quantitative and 8 qualitative). The top 12 quantitative papers and the top 2 qualitative papers with the highest scores were reported and summarized.Conclusions: This critical appraisal continues to be a useful tool for those working in anesthesiology education by highlighting the best research articles published over the year. Highlighting trends in medical education research in anesthesiology can help those in the field to think critically about the direction of this type of research.