scholarly journals 1439 A Change in The Use of Post-Operative Drains in Total Knee Arthroplasty (TKA)

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Erdman ◽  
R Ali ◽  
R Bhattacharya
Keyword(s):  
Blood Loss ◽  
Statistical Significance ◽  
Length Of Hospital Stay ◽  
Social Barriers ◽  
Estimated Blood Loss ◽  
Relevant Variables ◽  
Total Knee ◽  
Group 2 ◽  
Haematoma Formation ◽  
Group 1

Abstract Aim Closed suction drains (CSD) are routinely used to reduce the risk of haematoma formation and wound infections in TKA. Our study aims to determine if the use of drains has any impact on estimated blood loss, transfusion rates and length of stay in hospital. Method Elective TKA cases performed under a single consultant between February 2018-March 2020 were identified. Electronic medical records were reviewed, and data collected on relevant variables. Estimated blood loss was calculated using Ward’s formula. Mann-Whitney U test was applied to assess for statistical significance. Results A total of 86 elective TKA cases were included in the study. In 41 cases patients had a CSD insitu post-operatively (group 1), in the other 45 cases a drain was not used (group 2). Both groups had similar distributions of age, BMI, and sex. We found no statistically significant differences in mean change (+/-SD) in haemoglobin post-operatively between group 1 (21.3 (+/- 9.4)) and group 2 (19 (+/- 10)), (p = 0.34). Mean estimated blood loss was 915mls (+/-365) for group 1 and 871mls (+/-455) for group 2, (p = 0.45). Group 1 had a higher rate of transfusion (4.8% vs 2.2%); however, this was not statistically significant (p = 0.51). After accounting for unrelated medical complications or social barriers to discharge, the length of hospital stay was 4.7 (+/- 2.27) and 4.9 (+/- 3.14) for group 1 and 2 respectively, (p = 0.84). There were no reported cases of wound infection in both groups. Conclusions We found the use of drains in TKA confers no benefits in the outcomes evaluated.

Does Not Use of Closed Suction Drainage in Total Knee Arthroplasty with Tranexamic Acid Reduce Blood Loss?

2020 ◽  
Vol 22 (5) ◽  
pp. 343-352
Author(s):  
Naci Ruşen Senih Ayan ◽  
Yavuz Akalın ◽  
Nazan Çevik ◽  
Harun Sağlıcak ◽  
Burak Olcay Güler ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Background. The aim of this study was to compare outcomes in patients who received intravenous tranexamic acid just before and after total knee arthroplasty with or without drains and to analyze whether there is any difference in terms of blood loss. Material and methods. This is a retrospective analysis of prospectively collected data of patients undergoing unilateral total knee arthroplasty. Between March 2017 and March 2019, 97 knees of 94 consecutive patients with osteoarthritis were divided into two groups (Group 1, with drain; and 2, without drain). Drainage group (53 knees; average age, 66,1±7,0 years; male, 10; female, 43) and a drainless group (44 knees; average age, 63,7± 7,5 years; male, 4; female, 40). All patients received systemic tranexamic acid (in 100 mL saline infusion iv in 30 minutes prior to the tourniquet inflation and 3 hours after the operation). Blood loss, allogeneic blood transfusion rates, complications such as swelling of the cruris, infection (deep or superficial), thromboembolic incidents (Deep venous thrombosis or pulmoner thromboembolism) and length of hospital stay were assessed postoperatively. Results. There was no difference in demographic parameters, body mass index, side ofsurgery, ASA score and anesthesia type between 2 groups. The preoperative Hb levels were comparable but on the postoperative day one, Hb level was lower in the drain group (p=0,017). Total blood loss (TBL) and allogeneic transfusion rates were lower in the drainless group, although did not differ significantly between the two groups [TBL: 1360,9±502,5 / 646,1-2641,6 (1251,6) mL in the Group 1, 1205,6±505,0 / 396,6-2521,0 (1157,5) mL in Group 2 (p=0,134); Transfusion rates: 11 out of 53 cases (%20,8) in group 1 and 5 out of 44 cases (%11,4) in group 2]. The infection rate and length of hospital stay were lower in the drainless group. But there were no statistical difference was found in terms of complications and length of hospital stay between 2 groups. Conclusions. 1. Performing Total Knee Arthroplasty with preoperative and postoperative ivtranexamic acid and without drain decreased postoperative reduction in Hb level on the day after surgery in the current study. 2. But blood loss and blood transfusion rates when compared to patients with drain, no significant difference was found. 3. Drain use in knee replacements does not offer an advantage over drainless TKAs regarding the findings of our study. 4. Future studies with longer follow-up are needed in our opinion.

Role of Frameless Stereotaxy in the Surgical Treatment of Cerebral Arteriovenous Malformations: Technique and Outcomes in a Controlled Study of 44 Consecutive Patients

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1108-1118 ◽  
Author(s):  
Stephen M. Russell ◽  
Henry H. Woo ◽  
Seth S. Joseffer ◽  
Jafar J. Jafar
Keyword(s):  
Blood Loss ◽  
Arteriovenous Malformations ◽  
Operative Time ◽  
Controlled Study ◽  
Frameless Stereotaxy ◽  
Complication Rates ◽  
Cerebral Arteriovenous Malformations ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVE To describe a frameless stereotactic technique used to resect cerebral arteriovenous malformations (AVMs) and to determine whether frameless stereotaxy during AVM resection could decrease operative times, minimize intraoperative blood losses, reduce postoperative complications, and improve surgical outcomes. METHODS Data for 44 consecutive patients with surgically resected cerebral AVMs were retrospectively reviewed. The first 22 patients underwent resection without stereotaxy (Group 1), whereas the next 22 patients underwent resection with the assistance of a frameless stereotaxy system (Group 2). RESULTS The patient characteristics, AVM morphological features, and percentages of preoperatively embolized cases were statistically similar for the two treatment groups. The mean operative time for Group 1 was 497 minutes, compared with 290 minutes for Group 2 (P = 0.0005). The estimated blood loss for Group 1 was 657 ml, compared with 311 ml for Group 2 (P = 0.0008). Complication rates, residual AVM incidences, and clinical outcomes were similar for the two groups. CONCLUSION Frameless stereotaxy allows surgeons to 1) plan the optimal trajectory to an AVM, 2) minimize the skin incision and craniotomy sizes, and 3) confirm the AVM margins and identify deep vascular components during resection. These benefits of stereotaxy were most apparent for small, deep AVMs that were not visible on the surface of the brain. Frameless stereotaxy reduces the operative time and blood loss during AVM resection.

scholarly journals How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

2020 ◽  
pp. 1-9
Author(s):  
Ralph T. Schär ◽  
Shpend Tashi ◽  
Mattia Branca ◽  
Nicole Söll ◽  
Debora Cipriani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Elderly Patients ◽  
Age Groups ◽  
Head Ct ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

Oral tranexamic acid for an additional 24 hours postoperatively versus a single preoperative intravenous dose for reducing blood loss in total knee arthroplasty: results of a randomized controlled trial (TRAC-24)

2021 ◽  
Vol 103-B (10) ◽  
pp. 1595-1603
Author(s):  
Paul Magill ◽  
Janet C. Hill ◽  
Leeann Bryce ◽  
Una Martin ◽  
Al Dorman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Blood Loss ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
History Of ◽  
Total Knee ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aims In total knee arthroplasty (TKA), blood loss continues internally after surgery is complete. Typically, the total loss over 48 postoperative hours can be around 1,300 ml, with most occurring within the first 24 hours. We hypothesize that the full potential of tranexamic acid (TXA) to decrease TKA blood loss has not yet been harnessed because it is rarely used beyond the intraoperative period, and is usually withheld from ‘high-risk’ patients with a history of thromboembolic, cardiovascular, or cerebrovascular disease, a patient group who would benefit greatly from a reduced blood loss. Methods TRAC-24 was a prospective, phase IV, single-centre, open label, parallel group, randomized controlled trial on patients undergoing TKA, including those labelled as high-risk. The primary outcome was indirect calculated blood loss (IBL) at 48 hours. Group 1 received 1 g intravenous (IV) TXA at the time of surgery and an additional 24-hour postoperative oral regime of four 1 g doses, while Group 2 only received the intraoperative dose and Group 3 did not receive any TXA. Results Between July 2016 and July 2018, 552 patients were randomized to either Group 1 (n = 241), Group 2 (n = 243), or Group 3 (n = 68), and 551 were included in the final analysis. The blood loss did differ significantly between the two intervention groups (733.5 ml (SD 384.0) for Group 1 and 859.2 ml (SD 363.6 ml) for Group 2; mean difference -125.8 ml (95% confidence interval -194.0 to -57.5; p < 0.001). No differences in mortality or thromboembolic events were observed in any group. Conclusion These data support the hypothesis that in TKA, a TXA regime consisting of IV 1 g perioperatively and four oral 1 g doses over 24 hours postoperatively significantly reduces blood loss beyond that achieved with a single IV 1 g perioperative dose alone. TXA appears safe in patients with history of thromboembolic, cardiovascular, and cerebrovascular disease. Cite this article: Bone Joint J 2021;103-B(10):1595–1603.

Comparison of Incidence of Neonatal Anemia in Different Timing of Delayed Cord Clamping; at 30 Seconds, 1 Minute and 2 Minutes in Term Vaginal Delivery: A Randomized Controlled Trial

2020 ◽  
Vol 103 (12) ◽  
pp. 1255-1261
Keyword(s):  
Blood Loss ◽  
Controlled Trial ◽  
Controlled Study ◽  
Delayed Cord Clamping ◽  
Randomized Controlled ◽  
Cord Clamping ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: To compare the effect of cord clamping time on the incidence of neonatal anemia, clinical outcomes, and maternal and neonatal complications in term vaginal delivered newborns. Materials and Methods: A randomized controlled study was undertaken. Two hundred forty healthy full term vaginal delivered newborns were randomly allocated to either 30-seconds, 1-minute, or 2-minutes groups (group 1, 2, and 3) of umbilical cord clamping. During the interval between delivery and cord clamping, the attendant held the neonate supine at the level of the introitus. Neonatal venous hematocrit (Hct) was measured at 48 to 72 hours after birth. Results: Two hundred thirty newborns completed the present study. Neonatal anemia (Hct less than 45%) was detected in six of 77 cases (7.8%) in group 1, five of 76 cases (6.6%) in group 2, and three of 77 case (3.9%) in group 3, and there were no significant differences among the groups. Mean venous hematocrit values at 48 to 72 hours of life ± standard deviations were 53.1±6.4% in group 1, 53.0±5.5% in group 2, and 53.0±5.7% in group 3. The incidence of polycythemia (hematocrit more than 65%) and neonatal jaundice were similar among all the groups. There were no significant differences in the estimated postpartum blood loss and other neonatal outcomes. Conclusion: Neonatal hematocrit was not significantly different following delayed cord clamping (DCC) at 30-seconds, 1-minute, and 2-minutes, but the incidence of neonatal anemia decreased with the longer timing of DCC. The estimated blood loss and other complications were not different between the groups. Therefore, a minimum of a one minute DCC should be considered for neonatal anemic prevention when compared with the 30-seconds DCC. Keywords: Delayed cord clamping, Timing, Hematocrit, Neonatal anemia

scholarly journals The effect of prophylactic use of intravenous tranexamic acid in abdominal hysterectomy

2021 ◽  
Vol 7 (1) ◽  
pp. 1-5
Author(s):  
Dr. Smita Barya ◽  
◽  
Dr. Sameer Goyal ◽  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Abdominal Hysterectomy ◽  
Skin Incision ◽  
Postoperative Blood Loss ◽  
Abdominal Drain ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Prophylactic Use ◽  
Group 1

Introduction: Hysterectomy is one of the frequently performed major gynecological surgicalprocedures for various uterine pathologies. The objective of this study is to assess the effect ofintravenous tranexamic acid in reducing intraoperative and postoperative blood loss in womenundergoing abdominal hysterectomy. Materials and Methods: The study was a randomizeddouble-blind study, involving a total of 120 women undergoing abdominal hysterectomy for benignetiology were randomly assigned to two groups: Group 1 (non TA): (n=60) women receiving normalsaline and Group 2 (TA): (n=60) women receiving prophylactic Tranexamic Acid in 100 ml saline IVjust before skin incision. The primary outcome was intraoperative, postoperative, and all blood lossestimation. Results: Group 2 (TA) showed a great reduction in intraoperative and postoperativeblood loss (blood in the intra-abdominal drain) compared with Group 1 (non TA), (P = 0.0001,0.0001), so the overall estimated blood loss in groups 2 showed significant reduction compared withGroup 1 (P = 0.0001). Conclusion: Intravenous tranexamic acid is a safe and reliable method tohelp decrease blood loss during and after abdominal hysterectomy.

scholarly journals Decompression of lumbar canal stenosis with a bilateral interlaminar versus classic laminectomy technique: a prospective randomized study

2019 ◽  
Vol 46 (5) ◽  
pp. E3 ◽  
Author(s):  
Mohamed A. R. Soliman ◽  
Ahmed Ali
Keyword(s):  
Statistical Significance ◽  
Patient Comfort ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Low Back ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Group 1

OBJECTIVEThe aim of this study was to compare the radiological and clinical results of bilateral interlaminar canal decompression and classic laminectomy in lumbar canal stenosis (LCS).METHODSTwo hundred eighteen patients with LCS were randomized to surgical treatment with classic laminectomy (group 1) or bilateral interlaminar canal decompression (group 2). Low-back and leg pain were evaluated according to the visual analog scale (VAS) both preoperatively and postoperatively. Disability was evaluated according to the Oswestry Disability Index (ODI) preoperatively and at 1 month, 1 year, and 3 years postoperatively. Neurogenic claudication was evaluated using the Zurich Claudication Questionnaire (ZCQ) preoperatively and 1 year postoperatively. The two treatment groups were compared in terms of neurogenic claudication, estimated blood loss (EBL), and intra- and postoperative complications.RESULTSPostoperative low-back and leg pain declined as compared to the preoperative pain. Both groups had significant improvement in VAS, ODI, and ZCQ scores, and the improvements in ODI and back pain VAS scores were significantly better in group 2. The average EBL was 140 ml in group 2 compared to 260 ml in group 1. Nine patients in the laminectomy group developed postoperative instability requiring fusion compared to only 4 cases in the interlaminar group (p = 0.15). Complications frequency did not show any statistical significance between the two groups.CONCLUSIONSBilateral interlaminar decompression is an effective method that provides sufficient canal decompression with decreased instability in cases of LCS and increases patient comfort in the postoperative period.

Elective Laparoscopic Cholecystectomy – Is It Safe In The Hands Of Residents During Training?

2015 ◽  
Vol 87 (9) ◽  
Author(s):  
Michał Kisielewski ◽  
Michał Pędziwiatr ◽  
Magdalena Pisarska ◽  
Piotr Major ◽  
Mateusz Rubinkiewicz ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Blood Loss ◽  
Length Of Hospital Stay ◽  
Safe Procedure ◽  
Major Complications ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group 2 ◽  
Resident Group ◽  
Duration Of Operation ◽  
Group 1

Abstractwas to assess safety of elective laparoscopic cholecystectomy (LC) performed by residents that are undergoing training in general surgery.. A retrospective analysis was conducted on 330 patients operated electively due to cholelithiasis. Patients with acute cholecystitis, choledocholithiasis, undergoing cholecystec-tomy as a part of more extensive operation and patients with gall-bladder cancer were excluded. Group 1 included patients operated by resident, group 2 – by specialist. Duration of operation, mean blood loss, number of major complications, number of conversions to the open technique and conversions of the operator, reoperations and length of hospital stay were analyzed.Mean operative time overall was 81 min (25 – 170, SD±28.6) and 71 min (30-210, SD±29.1) in groups 1 and 2 respectively (p=0.00009). Mean blood loss in group 1 was 45±68.2 ml and in group 2 – 41±73.4 ml (p=0.23). Six major complications has occurred (1.81%) – 2 (2%) in group 1 and 4 (1.7%) in group 2. 18 cases (15.5%) of conversion of the operator occurred in group 1, and 6 cases (2.6%) of conversion of the operator happened in group 2. Average LOS was 1.9 days in group 1 and 2.3 days in group 2 (p=0.03979).Elective LC performed by a supervised resident is a safe procedure. Tactics of “conversion of operator” allowed to prevent major complications. Longer LC by residents is natural during the learning curve. Modifications of residency program in the field of laparoscopy may increase its accessibility.

scholarly journals Comparison of oral anticoagulant users with non-users admission laboratory parameters, length of hospital stay and outcomes in COVID-19 infection

2021 ◽  
Author(s):  
Faruk Karandere ◽  
Mehmet Hursitoglu ◽  
Erhan eroz ◽  
Ecenur Bilgin ◽  
Zeynep Karaali ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Statistical Significance ◽  
Oral Anticoagulants ◽  
Length Of Hospital Stay ◽  
Laboratory Parameters ◽  
Early Admission ◽  
Group 2 ◽  
Serum Crp ◽  
D Dimer ◽  
Group 1

Introduction Oral anticoagulants (OAs) are not in routine use during Coronavirus disease (COVID-19). Studies that compare the COVID-19 infection outcome of chronic OA users with their peers of non-OA users are available. To the best of our knowledge, none of these studies evaluated the effect of OA use on the COVID-19 related early admission laboratory parameters and/or length of the hospital stay. So, we will study these here. Methods  This retrospective study was included 2 groups; group 1 (n=62) consisted of OA users, and group 2 (n=75) of age, and sex-matched of OA non-users at the time of COVID-19 diagnosis. Early admission laboratory measures, numbers of comorbidities, length of hospital stay, and outcomes of these patients were recorded and analyzed Results Despite higher numbers of comorbidities in group 1, their serum CRP and D-dimer levels were significantly lower than the group 2. (p<0.05, all). The rate of mortality was higher in group 2 patients, but, it has not reached a statistical significance (p>0.05). Regression analysis showed that OA users (in comparison to non-OA users) had 0.980 and 0.520 times lower serum CRP and D-dimer levels, respectively.   Conclusions This study showed a beneficial effect of OA use on early admission serum CRP, and D-dimer levels, which are important prognostic predictors in COVID-19. Additionally, OA use associated with lesser hospital stay days of COVID-19 patients. These beneficial effects of OA use might help in improving the management of this infection after further dedicated studies in this field.

Laparoscopic Radical Nephrectomy for T2 Renal Cell Carcinoma

2009 ◽  
Vol 2 (3) ◽  
pp. 117-123
Author(s):  
Robert W. Ritchie ◽  
Mark E. Sullivan ◽  
Adam Jones
Keyword(s):  
Renal Cell Carcinoma ◽  
Blood Loss ◽  
Renal Cell ◽  
Outcome Data ◽  
Final Histology ◽  
Catchment Population ◽  
Operative Duration ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Group 1

Background: Large volume centres from the USA suggest laparoscopic radical nephrectomy (LRN) for T2 (>7 cm) renal cell carcinoma (RCC) is safe and associated with few complications. Similar data for low and intermediate volume centres in Europe is lacking. Objective: To determine whether LRN for T2 RCC in two intermediate volume UK hospitals compares favourably with larger volume centres. To determine whether LRN for T2 RCC is associated with favourable outcomes when compared to LRN for T1 RCC. Patients and methods: Data from 118 consecutive LRN performed in Oxford, UK (tertiary academic centre, catchment population 2,000,000) and Reading, UK (large district general hospital, catchment population 500,000). All patients undergoing LRN from 2004 to 2008 were included; outcome data were collected prospectively. All patients underwent a standard 4-port trans-peritoneal LRN with intact specimen removal. Patients were divided into two groups—Group 1 (clinical T1 tumours) and Group 2 (clinical T2 tumours). Demographic data and operative outcome data were collected for every patient including age, weight, operative duration, estimated blood loss, transfusion rates, complications, hospital stay and histology. Data were compared using Chi-square test and the Student t-test. Results: Mean patient age was 62.5 years; 57% of tumours were right sided. Mean tumour dimension in Group 1 was 4.3cm and 9.3cm in Group 2. Demographics were similar between the two groups. Operative duration, estimated blood loss and transfusion rates were significantly greater in Group 2. Despite this, complication rates, conversion rates and hospital stay were similar. 12% of tumours were benign and nearly half of all clinical T2 tumours were ultimately staged T3 on final histology. Conclusions: LRN for T2 RCC can be performed safely in intermediate volume centres. The procedure is more challenging but operative outcomes are similar to LRN for smaller tumours. Many >7 cm RCC are T3 on final histology.

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