RESUMO
BACKGROUND: There are no published studies on the simultaneous effect of extent and location of positive surgical margins (PSMs) on biochemical recurrence (BCR) after robot-assisted laparoscopic prostatectomy (RALP). The aim was to report the incidence, extent, and location of PSMs over the inclusion period as well as the rates of BCR and cancer-related mortality, and determine if BCR is associated with PSM extent and/or location. METHODS: Retrospective review of 530 consecutive patients who underwent RALP between 2003 and 2012. Kaplan-Meier (KM) survival analyses and Cox regressions were performed to determine variables associated with BCR. RESULTS: For the 530 operated patients, evaluated at a median of 92 months (IQR, 87-99), PSMs were observed in 156 (29%), of which 24% were focal. Out of 172 PSMs, 126 (73%) were focal and 46 (27%) were extensive. The KM survival using BCR as endpoint was 0.81 (CI, 0.78-0.85) at 5 years and was 0.67 (CI, 0.61-0.72) at 10 years; and using cancer-related mortality as endpoint was 0.99 (CI, 0.99-1.00) at 5 years and 0.95 (CI, 0.92-0.98) at 10 years. Multi-variable analysis revealed the strongest predictors of BCR to be Gleason score ≥ 8 (HR = 7.97; CI, 4.38-14.51) and 4 + 3 (HR = 3.88; CI, 2.12-7.07), lymph nodes invasion (HR = 3.42; CI, 1.70-6.91), pT stage 3b or 4 (HR = 3.07; CI, 1.93-4.90), and extensive apical PSMs (HR = 2.62; CI, 1.40-4.90) but not focal apical PSMs (HR = 0.86; CI, 0.49-1.50; p = 0.586). CONCLUSION: Extensive apical PSMs significantly increased the risk of BCR, independently from pT stage, Gleason score and lymph nodes invasion, while focal apical PSMs had no significant effect on BCR.
Assuntos
Calicreínas/sangue , Laparoscopia/métodos , Recidiva Local de Neoplasia/epidemiologia , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Biópsia , Intervalo Livre de Doença , Seguimentos , Humanos , Incidência , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Próstata/patologia , Próstata/cirurgia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Medição de Risco/métodos , Análise de SobrevidaAssuntos
Soronegatividade para HIV , Soropositividade para HIV/complicações , Complicações do Trabalho de Parto/cirurgia , Complicações Pós-Operatórias/etiologia , Incontinência Urinária/etiologia , Fístula Vesicovaginal/cirurgia , Adolescente , Adulto , Camarões , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Fístula Vesicovaginal/complicações , Adulto JovemRESUMO
OBJECTIVE: The objective of this study is to gain insight into the nature of obstetric fistulae in Africa through patient perspectives. STUDY DESIGN: At l'Hôpital Saint Jean de Dieu in Tanguieta, Benin, 37 fistula patients underwent structured interviews about fistula cause, obstacles to medical care, prevention, and reintegration by 2 physicians via interpreters. RESULTS: The majority of participants (43%) thought their fistulae were a result of trauma from the operative delivery. Lack of financial resources (49%) was the most commonly reported obstacle to care, and prenatal care (38%) was most frequently reported as an intervention that may prevent obstetric fistulae. The majority (49%) of the participants requested no further reintegration assistance aside from surgery. CONCLUSION: Accessible emergency obstetric care is necessary to decrease the burden of obstetric fistulae in Africa. This may be accomplished through increased and improved health care facilities and education of providers and patients.