RESUMEN
Cryotherapy is an ablative therapy that can be used to treat localized prostate cancer. In case of recurrence, treatment options are not well-defined, and their outcomes are unknown. We therefore collected all patients treated with radiotherapy after cryotherapy for prostate cancer recurrence in Nantes (France) between 2012 and 2019. We identified ten patients. After a median follow-up of 5 years, two patients presented late grade 3 toxicities; one patient presented a grade 3 rectal hemorrhage, and one had a grade 3 hematuria. Two patients relapsed at 61 and 62 months, and three patients died of other causes. Radiotherapy to treat local prostate cancer recurrence after cryotherapy seems feasible and effective in local control. These results do not allow us to recommend this technique in current practice but are encouraging for the conduct of prospective trials.
Asunto(s)
Crioterapia , Recurrencia Local de Neoplasia , Neoplasias de la Próstata , Radioterapia de Intensidad Modulada , Terapia Recuperativa , Humanos , Masculino , Neoplasias de la Próstata/radioterapia , Anciano , Terapia Recuperativa/métodos , Crioterapia/métodos , Radioterapia de Intensidad Modulada/métodos , Radioterapia de Intensidad Modulada/efectos adversos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/radioterapia , Anciano de 80 o más Años , Insuficiencia del TratamientoRESUMEN
The treatment of local prostate cancer recurrence after cryotherapy is challenging since the optimal management is unknown. We collected the available evidence to date to better define the risk and benefit of salvage radiotherapy (SRT) after cryotherapy failure for localized prostate cancer. This review confirms the feasibility of SRT in terms of biochemical control and late toxicity rate. However, the absence of comparative trials or prospective studies, coupled with the heterogeneity of patients treated and the variations in treatments delivered across the analyzed studies, highlights the need for cautious consideration when opting for salvage radiotherapy. Therefore, we highly recommend the inclusion of patients in dedicated clinical trials to comprehensively assess the efficacy and safety of this approach.
Asunto(s)
Criocirugía , Neoplasias de la Próstata , Masculino , Humanos , Criocirugía/efectos adversos , Estudios Prospectivos , Terapia Recuperativa , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Crioterapia , Neoplasias de la Próstata/radioterapia , Antígeno Prostático Específico , Resultado del TratamientoRESUMEN
INTRODUCTION: Management of testicular cancer requires a complete evaluation to confirm the localized stage and effective treatment according to guidelines to ensure the best outcome. The primary objective of this study was to evaluate practices at each stage of care in patients with a localized testicular tumor. The secondary objective was to evaluate the oncological prognosis of these patients according to the modalities of care. METHODS: We conducted a multicenter practice evaluation study with retrospective collection and evaluation of patient records. The study was conducted in two French departments (population pool of 2 million inhabitants) between January 1, 2010, and January 31, 2015, enabling a five-year followup of patients. Patients presenting with stage I testicular tumor according to the American Joint Committee on Cancer classification were included in the analysis. RESULTS: A total of 226 records were analyzed; 93% of patients underwent bilateral scrotal ultrasound and 93.25% had a chest-abdomen-pelvis computed tomography scan. A total of 29.65% of patients had a preoperative tumor marker assay in accordance with guidelines; 94% of patients had a total orchiectomy, with a median time of 15 days. At the end of the followup period, 17 patients had suffered a recurrence of their disease. Providing adjuvant care in accordance with guidelines reduced the risk of recurrence in patients with a seminomatous tumor. CONCLUSIONS: Our study showed heterogeneity in compliance with guidelines for evaluation and effective treatment of patients with a localized testicular tumor. Some essential practices, such as assays of tumor markers and fertility preservation for patients over 40 years, were not well carried out. Adjuvant management of localized tumors appears to be an important predictor of recurrence.
RESUMEN
Currently, vehicle-related particulate matter is the main determinant air pollution in the urban environment. This study was designed to investigate the level of fine (PM2.5) and coarse particle (PM10) concentration of roadside vehicles in Addis Ababa, the capital city of Ethiopia using artificial neural network model. To train, test and validate the model, the traffic volume, weather data and particulate matter concentrations were collected from 15 different sites in the city. The experimental results showed that the city average 24-hr PM2.5 concentration is 13%-144% and 58%-241% higher than air quality index (AQI) and world health organization (WHO) standards, respectively. The PM10 results also exceeded the AQI (54%-65%) and WHO (8%-395%) standards. The model runs using the Levenberg-Marquardt (Trainlm) and the Scaled Conjugate Gradient (Trainscg) and comparison were performed, to identify the minimum fractional error between the observed and the predicted value. The two models were determined using the correlation coefficient and other statistical parameters. The Trainscg model, the average concentration of PM2.5 and PM10 exhaust emission correlation coefficient were predicted to be (R2 = 0.775) and (R2 = 0.92), respectively. The Trainlm model has also well predicted the exhaust emission of PM2.5 (R2 = 0.943) and PM10 (R2 = 0.959). The overall results showed that a better correlation coefficient obtained in the Trainlm model, could be considered as optional methods to predict transport-related particulate matter concentration emission using traffic volume and weather data for Ethiopia cities and other countries that have similar geographical and development settings.
Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Ciudades , Monitoreo del Ambiente , Etiopía , Redes Neurales de la Computación , Tamaño de la Partícula , Material Particulado/análisis , Emisiones de Vehículos/análisisAsunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Procedimientos Quirúrgicos Mínimamente Invasivos/tendencias , Nefrectomía/estadística & datos numéricos , Nefrectomía/tendencias , Tratamientos Conservadores del Órgano/estadística & datos numéricos , Tratamientos Conservadores del Órgano/tendencias , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/tendencias , Atención a la Salud , Francia/epidemiología , Humanos , Tiempo de Internación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Nefrectomía/métodos , Nefronas , Tratamientos Conservadores del Órgano/métodos , Sistema de Registros , Procedimientos Quirúrgicos Robotizados/métodosRESUMEN
OBJECTIVE: To evaluate the oncologic outcomes of nephron-sparing surgery (NSS) for localized chromophobe renal cell carcinoma (cRCC). MATERIAL AND METHODS: We performed a multicenter international study involving the French Network for Research on Kidney Cancer (UroCCR) and 5 international teams. Data from 808 patients treated with NSS between 2004 and 2014 for non-clear cell RCCs were analyzed. RESULTS: We included 234 patients with cRCC. There were 123 (52.6%) females. Median age was 61 (23-88) years. Median tumor size was 3 (1-11)cm. A positive surgical margin was identified in 14 specimens (6%). Pathologic stages were T1, T2, and T3a in 202 (86.3%), 9 (3.8%), and 23 (9.8%) cases, respectively. After a mean follow-up of 46.6 ± 36 months, 2 (0.8%) patients experienced a local recurrence. No patient had metastatic progression, and no patient died from cancer. Three-years estimated cancer-free survival and cancer-specific survival were 99.1% and 100%, respectively. CONCLUSION: Oncological results of NSS for localized cRCC are excellent. In this series, only 2 patients had a local recurrence, and no patient had metastatic progression or died from cancer.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Recurrencia Local de Neoplasia , Nefronas , Tratamientos Conservadores del Órgano , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Renales/patología , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Neoplasia Residual , Estudios Retrospectivos , Tasa de Supervivencia , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the oncological outcomes of papillary renal cell carcinoma (pRCC) following nephron sparing surgery (NSS) and to determine whether the subclassification type of pRCC could be a prognostic factor for recurrence, progression, and specific death. MATERIALS AND METHODS: An international multicentre retrospective study involving 19 institutions and the French network for research on kidney cancer was conducted after IRB approval. We analyzed data of all patients with pRCC who were treated by NSS between 2004 and 2014. RESULTS: We included 486 patients. Tumors were type 1 pRCC in 369 (76 %) cases and type 2 pRCC in 117 (24 %) cases. After a mean follow-up of 35 (1-120) months, 8 (1.6 %) patients experienced a local recurrence, 12 (1.5 %) had a metastatic progression, 24 (4.9 %) died, and 7 (1.4 %) died from cancer. Patients with type I pRCC had more grade II (66.3 vs. 46.1 %; p < 0.001) and less grade III (20 vs. 41 %; p < 0.001) tumors. Three-year estimated cancer-free survival (CFS) rate for type 1 pRCC was 96.5 % and for type 2 pRCC was 95.1 % (p = 0.894), respectively. Three-year estimated cancer-specific survival rate for type 1 pRCC was 98.4 % and for type 2 pRCC was 97.3 % (p = 0.947), respectively. Tumor stage superior to pT1 was the only prognostic factor for CFS (HR 3.5; p = 0.03). CONCLUSION: Histological subtyping of pRCC has no impact on oncologic outcomes after nephron sparing surgery. In this selected population of pRCC tumors, we found that tumor stage is the only prognostic factor for cancer-free survival.
Asunto(s)
Carcinoma de Células Renales/clasificación , Neoplasias Renales/clasificación , Estadificación de Neoplasias , Nefrectomía/métodos , Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/cirugía , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Francia/epidemiología , Humanos , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Nefronas/cirugía , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management. METHODS: We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick's classification. RESULTS: Before TMT, thrombus level was staged I for 1 (7%), II for 10 (72%) and III (21%) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1-5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43%) patients had a measurable decrease, 6 (43%) had no change, and 2 (14%) had an increase in the thrombus. One patient (7%) had a downstage of thrombus level, 12 (85%) had stable thrombi, and 1 (7%) had an upstage. Regarding primary tumor, 7 (50%), 5 (36%) and 2 (14%) patients had a decrease, stabilization and an increase in tumor size, respectively. CONCLUSION: Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.
Asunto(s)
Carcinoma de Células Renales/terapia , Neoplasias Renales/terapia , Terapia Molecular Dirigida , Terapia Neoadyuvante , Nefrectomía , Trombectomía , Trombosis/cirugía , Vena Cava Inferior/cirugía , Adulto , Anciano , Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/epidemiología , Terapia Combinada , Comorbilidad , Relación Dosis-Respuesta a Droga , Femenino , Francia , Humanos , Indoles/uso terapéutico , Neoplasias Renales/epidemiología , Masculino , Persona de Mediana Edad , Niacinamida/análogos & derivados , Niacinamida/uso terapéutico , Compuestos de Fenilurea/uso terapéutico , Pirroles/uso terapéutico , Estudios Retrospectivos , Sorafenib , Sunitinib , Trombosis/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors > 7 cm. MATERIALS AND METHODS: We retrospectively analyzed data from 168 patients with tumors > 7 cm who were treated using NSS between 1998 and 2012. RESULTS: Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P = .001; hazard ratio [HR], 5) and tumor malignancy (P = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P = .023; HR, 4.2), positive surgical margin (P = .021; HR, 3.3), and Fuhrman grade > II (P = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P = .04; HR, 8.5) and Fuhrman grade > II (P = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. CONCLUSION: In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Nefrectomía/efectos adversos , Nefronas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Laparoscopía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Nefronas/fisiología , Estudios Retrospectivos , Factores de Riesgo , Robótica , Sobrevida , Tasa de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The present study assessed the incidence and histopathological features of incidentally diagnosed prostate cancer (PCa) in specimens from radical cystoprostatectomy (RCP) for bladder cancer. The patient outcomes also were evaluated. METHODS: We retrospectively reviewed the histopathological features and survival data of 4,299 male patients who underwent a RCP for bladder cancer at 25 French centers between January 1996 and June 2012. No patients had preoperative clinical or biological suspicion of PCa. RESULTS: Among the 4,299 RCP specimens, PCa was diagnosed in 931 patients (21.7%). Most tumors (90.1%) were organ-confined (pT2), whereas 9.9% of them were diagnosed at a locally advanced stage (≥pT3). Gleason score was <6 in 129 cases (13.9%), 6 in 575 cases (61.7%), 7 (3 + 4) in 149 cases (16.0%), 7 (4 + 3) in 38 cases (4.1%), and >7 in 40 cases (4.3%). After a median follow-up of 25.5 months (interquartile range 14.2-47.4), 35.4% of patients had bladder cancer recurrence and 23.8% died of bladder cancer. Only 16 patients (1.9%) experienced PCa biochemical recurrence during follow-up, and no preoperative predictive factor was identified. No patients died from PCa. CONCLUSIONS: The rate of incidentally diagnosed PCa in RCP specimens was 21.7%. The majority of these PCas were organ-confined. PCa recurrence occurred in only 1.9% of cases during follow-up.
Asunto(s)
Carcinoma in Situ/patología , Cistectomía , Hallazgos Incidentales , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Vejiga Urinaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma in Situ/mortalidad , Carcinoma in Situ/cirugía , Estudios de Seguimiento , Francia , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
BACKGROUND: The objective of this study was to assess the possibility of improving the reliability of preoperative detection of extracapsular extension (ECE) in each prostate lobe by using a new sign called sum of positive sextants per lobe (SPS-L), combining interpretation of MRI and prostate biopsy results. PATIENTS AND METHODS: We reviewed the charts of 590 patients undergoing radical prostatectomy between 2002 and 2007. All patients were assessed by preoperative 1.5 Tesla MRI using an integrated endorectal and pelvic phased array coil. A sextant was defined as "positive" when tumor infiltration was observed on a biopsy sample or a pathologic image was observed on MRI (0 = absent, 1 = present). A score, called sum of positive sextants per lobe (SPS-L), was defined as the sum of positive sextants on biopsy samples and positive sextants on MRI (MRI-L) for each lobe. A second score taking into account the presence or absence of ECE visualized on MRI (T3 MRI-L + SPS-L) was also tested for the detection of ECE per lobe. RESULTS: On multivariate analysis, the SPS-L and T3 MRI-L + SPS-L scores were significantly higher in the presence of ECE and extensive ECE (P < .0001). The areas under receiver operating characteristic (ROC) curves were significantly greater for the T3 MRI-L + SPS-L score than for the positive biopsy result per lobe (PB(+)/L) rate (P < .0001). CONCLUSION: The use of indirect signs (SPS-L) associated with direct signs (T3 MRI) allows the preoperative detection of ECE per lobe by endorectal 1.5 Tesla MRI with high sensitivity.
Asunto(s)
Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Prostatectomía/métodos , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/cirugía , Adulto , Anciano , Biopsia con Aguja Fina , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Estudios RetrospectivosRESUMEN
OBJECTIVE: The objective of this study was to evaluate survival and risk of recurrence in patients undergoing nephrectomy with resection of inferior vena cava tumour thrombus in our department. MATERIAL AND METHODS: From June 1991 to March 2003, 40 patients underwent radical nephrectomy with resection of inferior vena cava tumour thrombus. The upper limit of the tumour thrombus was below the hepatic veins in 21 cases (52.5%) and above the hepatic veins in 19 cases (47.5%), with thrombus in the right atrium in 6 cases (15%). Cardiopulmonary bypass (CPB) was used in 12 patients (30%) RESULTS: With a mean follow-up of 28.5 +/- 36.8 months (range: 0-150), 22 patients (55%) have died. The 2- and 5-year overall survival rates were 45.2% and 38. 7%, respectively. Local and/or metastatic recurrence was observed in 28 patients (70%) after a mean interval of 18 +/- 22.9 months (range: 1-104). Patients with tumour thrombus derived from the left kidney had a higher local recurrence rate than patients with thrombus derived from the right kidney (p = 0.0194). The 2- and 5-year recurrence-free survival rates were 28.3% and 8.9%, respectively. Only stage pN had a statistically significant prognostic value on overall survival, but not on recurrence-free survival. At the end of the study, only 1 patient (2.5%) can be considered to be cured with no disease progression with a sufficient follow-up (52 months) after nephrectomy. CONCLUSION: Nephrectomy with resection of tumour thrombus from the inferior vena cava provides a gain in terms of medium-term survival, but the majority of patients are not cured by this major surgery. Only lymph node status has a prognostic value.
Asunto(s)
Neoplasias Renales/secundario , Neoplasias Renales/cirugía , Células Neoplásicas Circulantes , Nefrectomía , Vena Cava Inferior , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , PronósticoRESUMEN
OBJECTIVE: The objective of this study was to evaluate the mortality and morbidity of patients operated for renal cancer with inferior vena cava extension according to the surgical management and the upper limit of the tumour thrombus. underwent radical nephrectomy with resection of neoplastic venous thrombus extending into the inferior vena cava. The upper limit of the tumour thrombus was below the hepatic veins in 21 cases (52.5%) and above the hepatic veins in 19 cases (47.50%) with invasion of the right atrium in 6 cases (150). RESULTS: Cardiopulmonary bypass (CPB) was used in 12 patients (30%). The transfusion rate was 87.5%. In the group of 19 patients with thrombus extending above the hepatic veins, the transfusion rate was lower in patients operated by CPB (p=0.008). Intraoperative embolism occurred in 3 patients (7.5%): 2 cases of thrombotic embolism and 1 case of gas embolism, always in patients operated without CPB. The early mortality was 7.5% from haemorrhagic complications. The early morbidity was 47.5%. No significant difference was observed between groups of patients operated with or without CPB in terms of morbidity (p=0.836) or mortality (p=0.896). CONCLUSION: The management of patients with renal cancer and inferior vena cava extension is complicated and requires a multidisciplinary approach. Patients operated under CPB for tumours extending above the hepatic veins have a lower transfusion rate and a lower embolic complication rate with no increase of mortality and morbidity.
Asunto(s)
Neoplasias Renales/cirugía , Células Neoplásicas Circulantes , Nefrectomía , Vena Cava Inferior , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Nefrectomía/efectos adversos , Nefrectomía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
OBJECTIVES: The aim of our survey was to evaluate surgical care, morbidity, mortality and follow-up of patients who had undergone surgical exeresis of a renal cancer with extension of tumor thrombus into the inferior vena cava. PATIENTS AND METHODS: Between June 1991 and March 2003, 40 (5.4%) patients were operated on for an enlarged nephrectomy with thrombectomy. The upper limit of the tumor thrombus was below the sus-hepatic veins in 21 (52.5%) patients and above the sus-hepatic veins in 19 (47.5%) patients with six (15%) located in the right atrium. RESULTS: Cardiopulmonary bypass (CPB) was used for 12 patients (30%). A per-operative embolism was noted for three (7.5%) patients: two cases of cruoric embolism and one case of gaseous embolism, systematically occurring in patients operated on without CPB. Early mortality was 7.5% (three patients) attributable to hemorrhagic complications. Overall survival at 2 and 5 years was 45.2% and 38.7%, respectively. Disease-free survival at 2 and 5 years was 28.3% and 8.9% respectively. Only the pN stage had a statistically significant prognosis value for overall survival but not for disease-free survival. At the end of the study, only one (2.5%) patient could be considered free of the disease with sufficient follow-up after the surgery. CONCLUSION: Patients with renal cancer and tumor extension in the inferior vena cava need multidisciplinary cooperation to adapt a good surgical strategy, particularly with the use of CPB. However, the rate of patients free of disease after such surgery was low.
Asunto(s)
Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Nefrectomía , Vena Cava Inferior/patología , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Renales/mortalidad , Masculino , Persona de Mediana Edad , Morbilidad , Invasividad Neoplásica , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
OBJECTIVE: Renal transplantation is a well defined surgical procedure, but it nevertheless remains associated with a risk of medical and surgical complications. Ureteric strictures, with an incidence ranging from 2% to 7.5% according to the series, are the most frequent urological complication. The objective of this study was to determine the incidence of ureteric strictures and the existence of risk factors predisposing to the development of ureteric strictures and to evaluate their consequences on patient and graft survival, based on a single-centre retrospective series of renal transplantations. PATIENTS AND METHODS: From January 1990 to December 2002, 1787 renal transplantations were performed consecutively in our centre. Graft, donor and recipient characteristics were extracted from a computerized database and validated by an independent observer. The parameters studied included donor's age and recipient's age, donor's haemodynamic status and serum creatinine at the time of harvesting, cause of death, graft weight and number of graft arteries, cold ischaemia and reperfusion times, number of HLA incompatibilities and percentage anti-HLA immunization, time to return of graft function, acute rejection, presence or absence of a double J stent, episodes of acute pyelonephritis, CMV infection and patient and graft survival according to the Kaplan-Meier method. RESULTS: Ureteric stricture was observed in 74 patients (4.1% of cases) and a donor age greater than 65 years (p < 0.0001), the presence of more than 2 arteries on the graft (p = 0.03) and recipients with an anti-HLA immunization less than 25% (p = 0.037) were identified as independent risk factors. Furthermore, grafts complicated by ureteric stricture resumed function later (p = 0.001). The development of ureteric stricture did not have an unfavourable impact on the 10-year recipient and graft survival rates.
Asunto(s)
Trasplante de Riñón/efectos adversos , Obstrucción Ureteral/etiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Supervivencia de Injerto , Antígenos HLA/inmunología , Humanos , Masculino , Persona de Mediana Edad , Arteria Renal/cirugía , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: Ureteric strictures, with a reported incidence ranging from 2% to 7.5%, are the most frequent urological complication of renal transplantation. This article reports the results of open surgery and percutaneous or endoscopic techniques used to treat these strictures, based on a single-centre retrospective series of renal transplantations. PATIENTS AND METHODS: From January 1990 to December 2002, in a series of 1787 consecutive renal transplantations performed in our centre, 74 were complicated by ureteric stricture (4.1% of cases). Strictures occurred at the ureterovesical implantation in 82.4% of cases and during the first year in 88% of cases. The mean time to management of the stricture after transplantation was 9 months (range: 6 days-120 months). Criteria of success were defined by regression or even resolution of ultrasound signs of dilatation associated with stabilization of serum creatinine obtained by the external urinary diversion. Surgical or percutaneous revisions (particularly repeated changes of double J stents) were considered to be treatment failures. RESULTS: 44 strictures (59.5% of cases) were treated by open surgery and 30 (40.5%) were treated by a first-line endoscopic or percutaneous technique. In our hands, open surgical techniques (ureteropelvic anastomosis: 80% of success (n=5), ureterovesical reimplantation: 82% of success (n=11), ureteroureteric anastomosis: 100% of success (n=4)) gave better results than endourological techniques (endoscopic electrical incision: 61.5% of success (n=13), double J stent: 61.5% of success (n=13), balloon catheter dilatation: no success (n=4)). CONCLUSION: Classical open surgical revision remains the reference treatment for ureteric strictures in renal transplantation for our team.
Asunto(s)
Trasplante de Riñón/efectos adversos , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
The authors report a case of small round cell desmoplastic tumour presenting as a testicular mass. This is a rare tumour arising from serosal tissues, especially the tunica vaginalis. It is characterized by a specific reciprocal translocation t(11;22) (p13;q12) inducing fusion of the EWS and WT1 genes. Treatment of this tumour consists of a combination of surgical resection, as complete as possible, and intensive chemotherapy (P6 protocol or Institut Gustave Roussy protocol) and possibly radiotherapy. However, the prognosis remains very poor.
Asunto(s)
Neoplasias Testiculares/patología , Adulto , Humanos , Masculino , Neoplasias Testiculares/terapiaRESUMEN
OBJECTIVE: To analyse the results of laparoscopic retroperitoneal radical nephrectomy in terms of feasibility, morbidity and disease control. PATIENTS AND METHODS: Between October 1997 and May 2004, 42 laparoscopic retroperitoneal radical nephrectomies were performed in 33 men and 9 women for renal tumour. Three or four trocars were used depending on the operative findings in order to achieve oncological imperatives: primary control of the renal pedicle before mobilization of the kidney (the artery was clipped and the vein was sectioned by Endo-GIA), passage in the plane of radical nephrectomy and absence of direct contact with the tumour The operative specimen was extracted whole in an impermeable endoscopic bag by enlarging a trocar orifice to avoid any parietal contact. RESULTS: 21 right radical nephrectomies and 21 left radical nephrectomies were performed in patients with a mean age of 61.8 years (range: 36 to 83 years). The mean size of the kidney was 120 mm (range: 60 to 170 mm), for a mean weight of 430 g (range: 55 to 870 g). The mean tumour size was 46.4 mm (range: 15 to 90 mm). The mean operating time was 132 min (range: 70 to 240 mm) for an estimated mean blood loss of 120 cc (range: 0 to 1000 cc). The mean hospital stay was 8.3 days (range: 4 to 26 days). Conversion was necessary for technical difficulties in 7 cases (16.7%), venous injuries in 5 cases, arterial injury in 1 case, and difficult dissection of the perirenal fat due to a history of high-grade diffuse lymphoma in remission. The final histological stage showed 31 pT1 tumours, one pT2 tumour and 10 pT3 tumours. Four patients died in a context of metastatic diseases with a mean follow-up for our series of 15 months (range: 1 to 64 months). CONCLUSION: Laparoscopic retroperitoneal radical nephrectomy is a feasible technique, which strictly complies with the principles of cancer surgery. The main complication observed in our series was bleeding, which appears to depend on the surgeon's experience.
Asunto(s)
Neoplasias Renales/cirugía , Laparoscopía , Nefrectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: The objective of this retrospective study was to evaluate the mortality and early and late morbidities of Bricker ileal conduit urinary diversion. PATIENTS AND METHODS: Between January 1990 and December 2002, 246 Bricker ileal conduit urinary diversion was performed in our centre in 164 males (67%) and 82 females (33%) with a mean age of 64 years (range: 9 to 90 years). Bricker diversion was performed in 73.6% of cases for underlying tumour (prostate, bladder, cervical, colon cancer), and in 26.4% of cases for benign disease (neurogenic bladder radiation bladder bladder exstrophy, incrusting cystitis). Cystectomy was associated with Bricker diversion in 62.2% of cases. The mean follow-up was 24 months (range: 1 to 151 months). The following parameters were studied: mortality and early and late medical or surgical, urological and gastrointestinal complications. RESULTS: The postoperative mortality was 6.9% (17 deaths, 16 in patients in whom Bricker diversion was performed for cancer). The early morbidity was marked by gastrointestinal complications (ileus, fistula, evisceration) in 46 cases (1.7%), 25 of which required re-operation. A medical complication was observed in 41 patients (16.7% of the series), responsible for 60% of the postoperative mortality (10 of the 17 deaths). A urinary fistula was observed in 7 patients (2.8%). The late morbidity consisted of parietal complications (incisional hernia, peristomal hernia, stricture of the stoma) in 18.3% of cases. Urological complications consisted of acute pyelonephritis (11%), ureteroileal stricture (4.9%) and urinary stones (4.9%). CONCLUSION: Bricker ileal conduit urinary diversion is associated with considerable mortality, especially in cancer patients. Early complications are essentially gastrointestinal, while late complications tend to be parietal or urological.
Asunto(s)
Derivación Urinaria/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Íleon/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Derivación Urinaria/efectos adversosRESUMEN
Retroperitoneal or transperitoneal laparoscopic radical nephrectomy is currently proposed by an increasing number of urologists as an alternative to conventional open surgery to treat renal tumours. The authors report a case of metastasis to unusual sites (sigmoid colon, small intestine, root of the nose) after converted retroperitoneal laparoscopic radical nephrectomy for a T3 renal tumour, which raises the problem of the possible role of the laparoscopic approach in this unusual metastatic progression of the disease.