RESUMO
BACKGROUND: This study prospectively evaluated the safety and efficacy of perineal hydrodissection in robot assisted nervesparing prostatectomy. METHODS: Patients were randomized for perineal, ultrasound guided hydrodissection (HD) before radical prostatectomy and compared with standard treatment (ST). Follow-up was done every 3 months, including erectile function (IIEF5-score), reported grade of erection, ability for sexual intercourse, continence, PSA. RESULTS: 21 patients were enrolled to this prospective study, 10 for ST and 11 for HD. No significant differences in demographic and preoperative oncological data between both groups were identified. Blood loss and time for surgery did not differ significantly. HD resulted in 66% (4/6) rate of positive surgical margins (PSM) in pT3 tumors vs 50% in ST (1/2; P = 0.67). Follow-up revealed higher IIEF scores, better ability for sexual intercourse and early continence in HD. CONCLUSIONS: Erectile function after radical prostatectomy was improved by perineal hydrodissection in this proof of principal study. However, careful patient selection and further studies are needed as perineal hydrodissection could result in increased positive surgical margins in pT3a tumors.
Assuntos
Prostatectomia/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Robótica/métodos , Idoso , Desenho de Equipamento , Disfunção Erétil , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Ereção Peniana , Períneo/cirurgia , Estudos Prospectivos , Próstata , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Robótica/instrumentação , Resultado do TratamentoRESUMO
Introducción. En este comunicado se resume el estado actual de la quimioterapia con docetaxel (DTX) como tratamiento de primera línea en pacientes con un cáncer de próstata metastásico (CPM) basado en los ensayos clínicos que investigan los resultados oncológico con este novedoso tratamiento. Material y Métodos. Se realizó un revisión no sistemática de artículos que evaluaban al doxetacel como tratamiento de primera línea en el tratamiento del CPM. 5 publicaciones fueron escogidas. Resultados. CHAARTED mostró 13,6 meses más de sobrevida con DTX + bloqueo hormonal (BH) (HR 0,61 y p: <0,001). ESTAMPEDE también mostró 10 meses más de sobrevida en el grupo DTX + BH (HR: 0.78 y p: 0.006). Además CHAARTED evidenció que el DTX redujo el riesgo de muerte del 39m por ciento (HR: 0,61; p <0,001) con una mejora de 17 meses en la sobrevida en el CPM voluminoso (CPMAV) Conclusión. Los datos de los ensayos CHAARTED y STAMPEDE sugieren beneficio en la sobrevida para pacientes con CPM, especialmente cuando los pacientes presentan un CPMAV.
Introduction. This paper summarizes the current status of docetaxel (DTX) chemotherapy as first-line treatment in patients with metastasic prostate cancer (MPC) based on cancer outcomes reported by trials with this novel treatment. Material and methods. A non-systematic review of articles that evaluated doxetacel as the first line of treatment for MPC was performed. 5 publications were selected. Results. CHAARTED showed 13.6 months more survival with DTX + androgénic deprivation (AD) (HR 0.61 and p: <0.001) and ESTAMPEDE also showed 10 months more survival with DTX + AD (HR: 0.78 and p: 0.006) than AD alone. In addition, CHAARTED showed that DTX reduced the risk of death by 39 pertcent (HR: 0.61, p <0.001) and 17 months more survival in bulky MPC (BMPC) Conclusions. Data from the CHAARTED and STAMPEDE trials suggest benefit in survival for patients with MPC, especially when patients have BMPC.
Assuntos
Masculino , Neoplasias da Próstata , Tratamento Farmacológico , AntineoplásicosRESUMO
OBJECTIVE: The presence of tumor cells in the spermatic cord was evaluated in patients undergoing inguinal testis study in order to assure if the placement of a clamp in it was necessary to avoid tumor dissemination. MATERIAL AND METHODS: Inguinal testis studies were performed over a two year period in 38 patients diagnosed of testicular mass. The presence of tumor cells in blood vessels or lymph nodes of the cord was evaluated in all of the patients. RESULTS: Testicular tumors were found in 28 patients (20 seminoma, 5 mixed tumor and 3 embryonal) with an average age of 42 (range 21-82) years. There were T1N0M0 21; T1N1M0 3; T2N0M0 2 and T2N1M0 2 cases, respectively. Independently of the stage and tumor lineage, tumor cells in the cord vessels were not observed in any of the cases through the pathology study. CONCLUSION: In our causistics, it seems that the surgical act consisting in the placement of a clamp early in the cord lacks a scientific foundation. However, this study does not make it possible to state that not performing this maneuver during the surgical procedure is oncologically safe. Thus, a precedent is established to perform studies with a larger number of patients that will make it possible to corroborate this observation. This would result in less traumatic and safer surgical techniques that would allow conserving the testis and its functionality.