Renal Cell Carcinoma with Venous Extension: Safety of Laparoscopic Surgery for Thrombus Levels I-IIIa.

Background: Novel studies are helping to consider minimally invasive surgery for treating patients with renal cell carcinoma and venous tumor thrombus. Evidence regarding its feasibility and safety is still sparse and does not include a subclassification for level III thrombi. We aim to compare the safety of laparoscopic vs open surgery in patients with levels I-IIIa thrombus. Materials and Methods: This is a cross-sectional comparative study using single-institutional data on adult patients treated surgically between June 2008 and June 2022. Participants were categorized into open and laparoscopic surgery groups. Primary outcome was difference in the incidence of 30-day major postoperative complications (Clavien-Dindo III-V) between groups. Secondary outcomes were differences in operative time, length of hospital stay, intraoperative blood transfusions, delta hemoglobin level, 30-day minor complications (Clavien-Dindo I-II), estimated overall survival, and progression-free survival between groups. A logistic regression model was performed including adjustment for confounding variables. Results: Overall, 15 patients in the laparoscopic group and 25 patients in the open group were included. Major complications occurred in 24.0% of patients within the open group and 6.7% of patients were treated laparoscopically (p = 0.120). Minor complications arose in 32.0% of patients treated with open surgery and in 13.3% of patients treated in the laparoscopic group (p = 0.162). Although not significant, there was a higher perioperative death rate within open surgery cases. The laparoscopic approach presented a crude odds ratio for major complications of 0.22 (95% confidence interval 0.02-2.1, p = 0.191) compared with open surgery. No differences were found between groups regarding oncologic outcomes. Conclusion: Laparoscopic approach for patients with venous thrombus levels I-IIIa seems to be as safe as open surgery.

[Percutaneous cryoablation for renal tumors cT1 as an alternative treatment for surgery]. / Crioablación percutánea de tumores renales cT1 como alternativa al tratamiento quirúrgico.

Renal cancer represents 3-4% of all malignancies. Its incidental detection is becoming more frequent. Surgery is the gold standard treatment for T1 renal cancer. Still, surgery is not suitable for every patient due to comorbidities or previous kidney surgery. Guidelines provided by The American Urological Association recommend thermoablation therapies as an alternative to surgery in tumors under 3 cm. Experience regarding percutaneous cryoablation in renal tumors is scarce in Latin America and there are only a handful of publications in this region regarding this subject. The objective of this study was to assess the effectiveness and security of percutaneous cryoablation in a cohort of adult patients with cT1 renal cancer (smaller than 5 cm) as an alternative to surgery. The procedures were performed with CT or Cone Beam CT guidance and under general anesthesia in sterile conditions. Cryoablation was carried out on an outpatient basis. Follow up was done with imaging studies, blood test and clinical consultation. All patients had complete response in imaging studies. There were no complications in 61% of all of them, the remaining patients suffered grade-1 complications such as hematuria, urinary retention and perirenal hematoma. In conclusion, percutaneous cryoablation for renal tumors is a safe and effective alternative to surgery.

El cáncer renal representa el 3 al 4% de todas las lesiones malignas y su detección incidental es cada vez más frecuente. Para los tumores renales cT1a la cirugía es el tratamiento de elección. No todos los pacientes son candidatos a este tipo de tratamiento por elevado riesgo quirúrgico debido a comorbilidades asociadas o antecedentes de cirugía en dicho órgano. Las guías de la Asociación Americana de Urología recomiendan la termoablación como alternativa a la cirugía en tumores menores a 3 cm. La experiencia con crioablación percutánea en tumores renales es escasa en Latinoamérica y hay pocas publicaciones al respecto en esta región. El objetivo de este trabajo fue describir la efectividad y seguridad de la crioablación percutánea en una cohorte de pacientes adultos con cáncer renal cT1 (menores a 5 cm) como alternativa al tratamiento quirúrgico. Los procedimientos fueron realizados con guía de tomografía computarizada o con un angiógrafo, en condiciones estériles y bajo anestesia general. Los pacientes fueron tratados en condiciones ambulatorias. El seguimiento se realizó con estudios por imágenes, análisis de laboratorio y consulta clínica. Todos tuvieron una respuesta completa constatada por imágenes en los controles evolutivos. El 61% no tuvo complicaciones y en el resto se observaron complicaciones grado 1 como hematuria, retención urinaria y hematoma perirrenal. Se concluyó que la crioablación percutánea es segura y efectiva como alternativa a la cirugía en pacientes con tumores renales.

Crioablación percutánea de tumores renales cT1 como alternativa al tratamiento quirúrgico / Percutaneous cryoablation of cT1 kidney tumors as alternative to surgical treatment

Resumen El cáncer renal representa el 3 al 4% de todas las lesiones malignas y su detección incidental es cada vez más frecuente. Para los tumores renales cT1a la cirugía es el tratamiento de elección. No todos los pacientes son candidatos a este tipo de tratamiento por elevado riesgo quirúrgico debido a comorbi lidades asociadas o antecedentes de cirugía en dicho órgano. Las guías de la Asociación Americana de Urología recomiendan la termoablación como alternativa a la cirugía en tumores menores a 3 cm. La experiencia con crioablación percutánea en tumores renales es escasa en Latinoamérica y hay pocas publicaciones al respecto en esta región. El objetivo de este trabajo fue describir la efectividad y seguridad de la crioablación percutánea en una cohorte de pacientes adultos con cáncer renal cT1 (menores a 5 cm) como alternativa al tratamiento quirúrgico. Los procedimientos fueron realizados con guía de tomografía computarizada o con un angiógrafo, en condiciones estériles y bajo anestesia general. Los pacientes fueron tratados en condiciones ambulatorias. El seguimiento se realizó con estudios por imágenes, análisis de laboratorio y consulta clínica. Todos tuvieron una respuesta completa constatada por imágenes en los controles evolutivos. El 61% no tuvo complicaciones y en el resto se observaron complicaciones grado 1 como hematuria, retención urinaria y hematoma perirrenal. Se concluyó que la crioablación percutánea es segura y efectiva como alternativa a la cirugía en pacientes con tumores renales.

Abstract Renal cancer represents 3-4% of all malignancies. Its incidental detection is becoming more frequent. Surgery is the gold standard treatment for T1 renal cancer. Still, surgery is not suitable for every patient due to comorbidities or previous kidney surgery. Guidelines provided by The American Urological Association recommend thermoablation therapies as an alternative to surgery in tumors under 3 cm. Experience regarding percutaneous cryoablation in renal tumors is scarce in Latin America and there are only a handful of publications in this region regarding this subject. The objective of this study was to assess the effectiveness and security of percutaneous cryoablation in a cohort of adult patients with cT1 renal cancer (smaller than 5 cm) as an alternative to surgery. The procedures were performed with CT or Cone Beam CT guidance and under general anesthesia in sterile conditions. Cryoablation was carried out on an outpatient basis. Follow up was done with imaging studies, blood test and clinical consultation. All patients had complete response in imaging studies. There were no complications in 61% of all of them, the remaining patients suffered grade-1 complications such as hematuria, urinary reten tion and perirenal hematoma. In conclusion, percutaneous cryoablation for renal tumors is a safe and effective alternative to surgery.

von Hippel-Lindau mutants in renal cell carcinoma are regulated by increased expression of RSUME.

Renal cell carcinoma (RCC) is the major cause of death among patients with von Hippel-Lindau (VHL) disease. Resistance to therapies targeting tumor angiogenesis opens the question about the underlying mechanisms. Previously we have described that RWDD3 or RSUME (RWD domain-containing protein SUMO Enhancer) sumoylates and binds VHL protein and negatively regulates HIF degradation, leading to xenograft RCC tumor growth in mice. In this study, we performed a bioinformatics analysis in a ccRCC dataset showing an association of RSUME levels with VHL mutations and tumor progression, and we demonstrate the molecular mechanism by which RSUME regulates the pathologic angiogenic phenotype of VHL missense mutations. We report that VHL mutants fail to downregulate RSUME protein levels accounting for the increased RSUME expression found in RCC tumors. Furthermore, we prove that targeting RSUME in RCC cell line clones carrying missense VHL mutants results in decreased early tumor angiogenesis. The mechanism we describe is that RSUME sumoylates VHL mutants and beyond its sumoylation capacity, interacts with Type 2 VHL mutants, reduces HIF-2α-VHL mutants binding, and negatively regulates the assembly of the Type 2 VHL, Elongins and Cullins (ECV) complex. Altogether these results show RSUME involvement in VHL mutants deregulation that leads to the angiogenic phenotype of RCC tumors.

Adrenalectomía laparoscópica: ¿abordaje retroperitoneal posterior o transperitoneal lateral? / Laparoscopic Adrenalectomy: posterior retroperitoneoscopic or lateral transperitoneal approach?

Objetivo: comparar los resultados obtenidos en adrenalectomía retroperitoneoscópica posterior (ARP) con los obtenidos por vía transperitoneal lateral (ATL) a corto y mediano plazo. Material y métodos: estudio de cohortes prospectivo. Se incluyeron 22 pacientes a quienes se les realizaron 24 adrenalectomías (12 ARP y 12 ATL) entre los meses de enero de 2015 y mayo de 2016. En el grupo ARP se realizó a 1 paciente adrenalectomía bilateral simultánea y a 1 paciente, bilateral sincrónica. Fueron comparados datos basales, clínicos, quirúrgicos y evolutivos. Resultados: la mediana de tiempo de seguimiento fue de 6,5 meses (r 1-16). Los grupos ARP y ATL fueron comparables en edad, sexo, BMI y presencia de cirugías previas. Los adenomas fueron las lesiones predominantes (41,7% en cada grupo). El promedio de tiempo operatorio en ART y ATL fue 104,3 ± 21,2 y 146 ± 32,9 minutos, respectivamente (p 0,05). No hallamos diferencias en tiempo de internación, sangrado y complicaciones. Todos los pacientes lograron curación clínica. Conclusiones: la técnica ARP es una vía segura, con resultados comparables a ATL y menor tiempo operatorio. También permite intervenir de manera simultánea y sincrónica ambas glándulas adrenales sin necesidad de reposicionar al paciente.

Objetive: to compare the results of posterior retroperitoneoscopic (PRA) or lateral transperitoneal approach (LTA) in laparoscopic adrenalectomy in the short and medium term. Material y methods: prospective cohort study. We included 22 patients who underwent 24 adrenalectomies (12 PRA and 12 LTA) between January 2015 and May 2016. In the PRA group, two simultaneous bilateral laparoscopic adrenalectomies were performed (1 synchronous bilateral adrenalectomy). Baseline, clinical and surgical outcome were compared. Results: the median follow-up time was 6.5 months (range: 1-16). The PRA and LTA groups were comparable in age, gender, BMI and presence of previous surgeries. Adenomas were the predominant lesions (41.7% in each group). The average operating time in PRA and LTA was 104.3 ± 21.2 and 146 ± 32.9 minutes, respectively (p=0.05). We found no differences in length of hospital stay, bleeding and complications. All patients achieved clinical cure. Conclusions: the PRA technique is a safe approach, with results comparable to LTA and shorter operating time. It also allows to intervene simultaneously and synchronously both adrenal glands without the need of repositioning the patient.