RESUMEN
BACKGROUND: To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis. METHODS: A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model. RESULTS: PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979-2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series. CONCLUSIONS: PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine.
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Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/mortalidad , Neoplasias Renales/diagnóstico , Neoplasias Renales/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Anciano , Carcinoma de Células Renales/secundario , Carcinoma de Células Renales/cirugía , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , América Latina , Masculino , Persona de Mediana Edad , Nefrectomía/métodos , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
PURPOSE: To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. METHODS: Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. RESULTS: We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. CONCLUSION: Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.
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Adenoma Oxifílico/cirugía , Angiomiolipoma/cirugía , Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Nefrectomía/métodos , Complicaciones Posoperatorias/epidemiología , Adenoma Oxifílico/patología , Anciano , Angiomiolipoma/patología , Pérdida de Sangre Quirúrgica , Carcinoma de Células Renales/patología , Conversión a Cirugía Abierta , Bases de Datos Factuales , Femenino , Laparoscópía Mano-Asistida/métodos , Humanos , Estimación de Kaplan-Meier , Neoplasias Renales/patología , Laparoscopía/métodos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Márgenes de Escisión , México , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Análisis Multivariante , Estadificación de Neoplasias , Tempo Operativo , Modelos de Riesgos Proporcionales , Procedimientos Quirúrgicos Robotizados/métodos , América del Sur , España , Carga Tumoral , Isquemia TibiaRESUMEN
OBJECTIVE: To present mid-term outcomes from an international, multi-institutional cohort of patients undergoing vessel-sparing excision and primary anastomosis urethroplasty for the reconstruction of the anterior urethra. MATERIALS AND METHODS: From June 2003 to December 2011, 68 patients underwent vessel-sparing anterior urethral reconstruction at five different international institutions using the vessel-sparing technique described by Jordan et al. (J Urol 177(5):1799-1802, 2007). RESULTS: Patients' age range was from 3 to 82 years (mean 51.2). Stricture length ranged from 1 to 3 cm (mean 1.78). After a mean follow-up of 17.6 months, 95.6 % of patients had a widely patent urethral lumen. Three patients failed the procedure, requiring either direct vision internal urethrotomy or urethral dilation, after which all were free of symptoms and did not require further instrumentation. Complications were minimal and as expected following open urethroplasty. CONCLUSION: Preservation of blood supply is a noble pursuit in surgery; however, it can be technically difficult and often requires more time and effort. This vessel-sparing technique for anterior urethral reconstruction is reproducible and appears to be reliable in this international cohort. Larger studies and longer follow-up are needed to support these encouraging results.
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Procedimientos de Cirugía Plástica , Estrechez Uretral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Niño , Preescolar , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Estrechez Uretral/diagnóstico , Estrechez Uretral/etiología , Adulto JovenRESUMEN
A case of a patient with diagnosis of Solitary Fibrous Tumor of de urinary bladder is presented. A 69 year old man presented with abdominal pain localized at the hypogastrium. In the computed tomography appears a mass of 100â¯×â¯80 mm at the minor pelvis. Mass resection, radical cystoprostatectomy and ileal conduit diversion were done. A Solitary Fibrous Tumor of the urinary bladder was diagnosed. CD 34 (+). Surgical resection with negative margins has curative intention. Is necessary long-term follow up to assure there is not local or distant recurrence.