Andrew A. Wagner, MD
Associate Professor of Surgery, Harvard Medical School
Director, Minimally Invasive Urologic Surgery
Director, Minimally Invasive Urologic Surgery Fellowship Program
Peter Chang, MD, MPH
Joan Delto, MD
Catrina Crociani, MPH
Jialin Mao, MPH
Adrien Waisman, MD
Our group is interested in evaluating recovery trends (as measured by prospectively collecting patient reported quality of life data) after kidney surgery. Using this data we are able to provide detailed recovery expectations for these patients. We also aim to define the costs of kidney surgery, including hospital costs and societal costs — by incorporating patient-reported data about leave from work, salary lost, and family leave. We were the first group to evaluate societal costs of kidney surgery in the period following hospital discharge. This work was first presented at the New England AUA meeting in 2015, and has been accepted for publication in the Canadian Journal of Urology in 2018.
Our team has helped refine robotic surgery for kidney cancer; however we are also interested in non-operative approaches to small renal masses. Together with researchers from Johns Hopkins University and Columbia University, we are a main contributor to the DISSRM trial (Delayed Intervention and Surveillance for Small Renal Masses). This is a multicenter prospective study evaluating the role of surveillance and surgery of small kidney tumors over time. We have studied quality of life in these patients, evaluated changes in kidney function over time, evaluated tumor growth characteristics, and developed a scoring system to help clinicians during the decision-making process.
For over a decade, BIDMC has been a leader in evaluating quality of life for prostate cancer patients. Our group developed the EPIC-CP, a short form quality of life instrument used by clinicians worldwide to evaluate prostate cancer patients. Updates from this work were recently published in the Journal of Urology in 2017. Our group is also the area’s leader in active surveillance for low risk prostate cancer. We are the only Northeast member of the Canary Prostate Cancer Active Surveillance Study (Canary-PASS). This is the largest prospective multi-center study of active surveillance for prostate cancer, with over 1,700 patients enrolled. We are collecting clinical data and biologic samples from patients in an effort to identify important biomarkers that could distinguish which patients have more aggressive prostate cancer from those with indolent disease. Recently we have looked at the timing of cancer progression, use of a four-kallikrein panel for prediction of prostate cancer progression, and evaluated a genomic index in cancer progression.
We are the first urology team in Boston to regularly perform radical cystectomy and urinary diversion completely robotically. We are gathering prospective data with a focus on clinical outcomes and validated quality of life. We also recently joined the IRCC (International Radical Cystectomy Consortium) for radical cystectomy, a large (50 center) database project aimed at evaluating trends in cystectomy treatment over time. This work was also presented at the 2015 New England AUA meeting, and will be presented as a podium presentation at the 2018 AUA meeting in San Francisco.
- We published the first prospective evaluation of quality of life after robotic prostatectomy using the EPIC-CP short-form instrument
- We’ve enrolled over 175 patients on the prospective prostate cancer active surveillance study (Canary-PASS)
- We published the first known evaluation of quality of life outcomes following laparoscopic adrenalectomy
- We trained our 5th Minimally Invasive Urology Fellow, Marc Mangianello, MD and our fellowship became officially endowed by our grateful patients
Teaching, Training, and Education
In addition to training our urology residents, in July 2010, we launched a Minimally Invasive Urologic Surgery Fellowship Program. Our fellowship was recently endowed by our grateful patients and is now the Esta and Robert Epstein Fellowship in Minimally Invasive Urologic Surgery. This fellowship is a unique training opportunity in New England, allowing fellows exposure to several hundred major laparoscopic and robotic surgery cases per year as well as exposure to our research program.
Selected Research Support
Canary Prostate Cancer Active Surveillance Study (PASS); Canary Foundation, 2010-present; BIDMC Site PI: Andrew A. Wagner, MD
Wagner AA, Cheng PJ, Carneiro A, Dovirak O, Khosla A, Taylor KN, Crociani CM, McAnally KC, Percy A, Dewey LE, Sanda MG, Chang P. Clinical use of expanded prostate cancer index composite for clinical practice to assess patient-reported prostate cancer quality of life following robot-assisted radical prostatectomy. J Urol 2017;197:109-14.
Althaus AB, Dovirak O, Chang P, Taylor KN, O’Halloran TD, Wagner AA. Aspirin and clopidogrel during robotic partial nephrectomy, is it safe? Can J Urol 2015;22(2):7984-9.
Dovirak O, Chang P, Mao J, Taylor K, Wagner AA. How to quantify recovery after laparoscopic adrenalectomy: an assessment of patient-reported health-related quality of life. Surg Laparosc Endosc Percutan Tech 2016;26(4):290-4.
Uzosike AC, Patel HD, Alam R, Schwen ZR, Gupta M, Gorin MA, Johnson MH, Gausepohl H, Riffon MF, Trock BJ, Chang P, Wagner AA, McKiernan JM, Allaf ME, Pierorazio PM. Growth kinetics of small renal masses on active surveillance: Variability and results from the DISSRM registry. J Urol 2017;[Epub ahead of print].
Macleod LC, Ellis WJ, Newcomb LF, Zheng Y, Brooks JD, Carroll PR, Gleave ME, Lance RS, Nelson PS, Thompson IM Jr, Wagner AA, Wei JT, Lin DW. Timing of adverse prostate cancer reclassification on first surveillance biopsy: Results from the Canary Prostate Cancer Active Surveillance Study. J Urol 2017;197:1026-33.
Lin DW, Newcomb LF, Brown MD, Sjoberg DD, Dong Y, Brooks JD, Carroll PR, Cooperberg M, Dash A, Ellis WJ, Fabrizio M, Gleave ME, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Zheng Y; Canary Prostate Active Surveillance Study Investigators. Evaluating the four kallikrein panel of the 4Kscore for prediction of high-grade prostate cancer in men in the Canary Prostate Active Surveillance Study. Eur Urol 2017;72(3):448-454.