RESUMEN
BACKGROUND: The prognostic value of pretreatment lymphocyte to monocyte ratio in patients with renal cell carcinoma and, especially, in non-metastatic patients remains controversial. METHODS: We conducted a PRISMA-compliant meta-analysis to systematically assess the prognostic value of LMR in patients with non-metastatic RCC. Overall survival, cancer-specific survival, and disease-free survival were analyzed. Pooled hazard ratios and 95% confidence intervals were calculated. RESULTS: Seven studies comprising 4666 patients were included in the analysis. Unlike those observed in a previous meta-analysis, a lower lymphocyte to monocyte ratio was associated with poorer cancer-specific survival (fix-effect model, hazard ratio 3.04, 95% confidence intervals 2.05-4.51, Pâ<â.05). Heterogeneity Chi-squared value Q expâ=â0. (Pâ=â.82) (I2â=â0%). However, the association between a low lymphocyte to monocyte ratio and overall survival or disease-free survival did not obtain significance. CONCLUSION: A lower lymphocyte to monocyte ratio implied poor cancer-specific survival in patients with non-metastatic renal cell carcinoma. Prospective studies are required to confirm our findings. REGISTRATION NUMBER: ClinicalTrials.gov (identifier: NCT04213664).
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Humanos , Carcinoma de Células Renales/inmunología , Carcinoma de Células Renales/mortalidad , Neoplasias Renales/inmunología , Neoplasias Renales/mortalidad , Recuento de Linfocitos , PronósticoRESUMEN
OBJECTIVE: Transperitoneal laparoscopic adrenalectomy (TLA) is considered the treatment of choice for small and benign adrenal tumors. In the recent years, posterior retroperitoneoscopic adrenalectomy (PRA) has gained popularity due to its advantages over TLA, presenting a shorter surgical time and a faster recovery without increasing complications. Conversely, a greater learning curve is considered because the use of a different and unusual surgical field. MATERIAL AND METHODS: Our objective is to describe the PRA technique to ass our initial experience evaluating its feasibility, safety and effectiveness in a prospective series of patients. A total of 11 (9 left and 2 right) PRA performed between March 2017 and February 2020 were analyzed. RESULTS: Median age was 55 (36-65) years with a median BMI of 25.69 (20.8-34.5) Kg/m2. 54.55% had ASA≥3. 63.37% of adrenal tumors were hormonally functional. The tumor mean size was 4 cm (0.6-8) and cortical adenoma was the predominant pathological anatomy (72.72%). No pheochromocytoma was operated. Median operative time was 87 minutes (35-125) with an intraoperative bleeding of 50 (0-300) mL. No patient presented intraoperative complications or reconversion. Median length of stay was 1 (1-6) days. Only one patient presented postoperative complications. CONCLUSION: The PRA is feasible, reproducible and safe, even during the initial learning curve, presenting a clear early recovery with a shorter surgical time.
OBJETIVO: La suprarrenalectomía laparoscópica transperitoneal (SLT) se considera el tratamiento de elección de los tumores suprarrenales benignos y de pequeño tamaño. En los últimos años el acceso retroperitoneoscópico en decúbito prono (SRP) ha ganado popularidad por las ventajas que ofrece con respecto a la SLT, al emplear un menor tiempo quirúrgico y obtener una recuperación más rápida sin aumentar las complicaciones, a expensas de una curva de aprendizaje dificultada por emplear un campo quirúrgico diferente al habitual.MATERIAL Y MÉTODOS: Nuestro objetivo es describir la técnica quirúrgica de SRP y nuestra experiencia inicial evaluando su factibilidad, seguridad y efectividad en una serie prospectiva de pacientes. Se analizaron un total de 11 SRP (9 izquierdas y 2 derechas) realizadas entre marzo de 2017 y febrero de 2020. RESULTADOS: La mediana de edad fue de 55 (36-65) años con un IMC de 25,69 Kg/m2 (20,8-34,5). El 54,55% tenía un ASA≥3. El 63,37% de los tumores suprarrenales fueron hormonalmente funcionantes. El tamaño medio fue de 4 cm (0,6-8), siendo el adenoma cortical la anatomía patológica predominante (72,72%). No se realizó ningún feocromocitoma. La mediana de tiempo quirúrgico fue de 87 minutos (35-125) con un sangrado intraoperatorio de 50mL (0-300). Ningún paciente presentó complicaciones intraoperatorias o reconversión. La mediana de días de ingreso fue de1 (1-6) día. Sólo un paciente presentó complicaciones postoperatorias. CONCLUSIONES: La SRP es factible, reproducible y segura, incluso durante la curva de aprendizaje inicial, presentando una clara recuperación temprana con un tiempo quirúrgico corto.