[Ambulatory prostate photoselective vaporisation with GreenLight laser (180W): prospective evaluation from 115 patients]. / Vaporisation laser prostatique par GreenLight (180 W) en ambulatoire: évaluation prospective sur 115 patients.

OBJECTIVE: The goal of this prospective study was the evaluation of ambulatory (less than 12h) prostate photoselective vaporisation (PVP) with GreenLight laser XPS. MATERIEL AND METHODS: One hundred and fifteen consecutive patients eligible for ambulatory procedure according to selective criteria (age less than 80, no anticoagulation treatment, no diabetes, patient not alone at home) who underwent ambulatory PVP from 1st May 2012 to 30th June 2013 have been evaluated. The principal criterion was the success rate of ambulatory. Secondary criteria were 3 months functional results and complication rate and satisfaction rate on ambulatory procedure. RESULTS: Around 93.1% patients were successfully treated in ambulatory procedure. The main reason of failure was organizational. There were 2 conversions in monopolar resection and one operative complication. At 3 months, there were 11.5% grade 2 complications with 3.48% rehospitalizations and no reintervention. CONCLUSION: This study demonstrates the feasibility of ambulatory PVP. This procedure should be proposed to selected patients.

[New anti-angiogenic strategies in the management of kidney cancer]. / Nouvelles stratégies anti-angiogéniques dans la prise en charge du cancer du rein.

INTRODUCTION: The aim of this study was to clarify the current role of adjuvant and neo-adjuvant in the treatment of kidney cancer. MATERIALS AND METHODS: The data were explored in Medline (http://www.ncbi.nlm.nih.gov) using the following MeSH terms or combinations of these keywords: "cancer", "rein", "kidney", "adjuvant", "neoadjuvant", "antiangiogenique", "antiangiogenic" and selecting the items produced in their methodology, their relevance to the theme explored and their date of publication. RESULTS: Thirty-two English and French items published between 2001 and 2011 were selected: five studies of evidence level 1, nine level 2 studies, nine level 4 studies, five studies at level 5 and four literature reviews. The cytoreductive nephrectomy as first-line treatment of locally advanced or metastatic kidney cancer is now controversial with the advent of new targeted anti-angiogenic therapies. In neoadjuvant setting, these treatments showed a moderate decrease in tumor volume and rarely improved resectability. In adjuvant setting, their place has yet to be specified and several trials are currently underway. CONCLUSION: Recent years have seen the anti-angiogenic therapeutic strategies upset in locally advanced and metastatic renal cancer. The development of clinical trials and research protocols will allow us to determine in the near future the optimal therapeutic sequences.

[Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function outcome in tumors larger than 4 cm]. / Intérêt de la néphrectomie partielle pour la préservation de la fonction rénale des patients ayant une tumeur rénale de plus de 4 cm.

OBJECTIVE: The objective of the present study was to analyse whether nephron-sparing surgery (NSS) was superior to radical nephrectomy (RN) in preserving renal function outcome in tumors larger than 4cm. METHODS: The data from 888 patients who had been operated upon at eight french university hospitals were retrospectively analyzed. Glomerular filtration rate (GFR) pre- and post-surgery was calculated with the abbreviated Modification of Diet in Renal Disease (MDRD) equation. For a fair comparison between the two techniques, all imperative indications for NSS and all GFR<30 mL/min/1.73 m(2) were excluded from analysis. A shift to a less favorable DFG group following surgery was considered clinically significant. RESULTS: Seven hundred and thirty patients were suitable for comparison. Median age at diagnosis was 60 years (19-88). Tumors measuring more than 4cm represented 359 (49.2%) cases. NSS and RN were performed in 384 (52.6%) and 346 (47.4%) patients, respectively. In univariate analysis, patients undergoing NSS had a smaller risk than RN of developing significant GFR change following surgery. This was true for tumors≤4cm (P=0.0001) and for tumors>4cm (P=0.018). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P=0.001), decreased preoperative DFG (P=0.006), increased age at diagnosis (P=0.001) and increased ASA score (P=0.004). CONCLUSION: The renal function benefit offered by elective NSS over RN persists even when expanding NSS indications beyond the traditional 4 cm cut-off.