Development of an immune-nutritional prognostic index in patients with muscle-infiltrating bladder cancer candidates for radical cystectomy.

INTRODUCTION: Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear. OBJECTIVE: Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1). MATERIAL AND METHODS: A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan-Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis. RESULTS: Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate-poor prognostic groups. CONCLUSION: The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT.

Elaboración de un índice pronóstico inmunonutricional en pacientes con cáncer de vejiga músculo-infiltrante candidatos a cistectomía radical / Development of an immune-nutritional prognostic index in patients with muscle-infiltrating bladder cancer candidates for radical cystectomy

Introducción El tumor vesical músculo-infiltrante (TVMI) tiene una supervivencia libre de recidiva (SLR) del 50% a los cinco años, la quimioterapia neoadyuvante (QTN) ha aumentado la misma un 8%, pero no está claro qué pacientes se pueden beneficiar en mayor grado de la misma. Objetivo Evaluar el valor pronóstico del estado inmunológico-nutricional en los pacientes con TVMI candidatos a cistectomía, y desarrollar un score que permita identificar precistectomía a los pacientes con peor pronóstico (pT3-4 y/o pN0-1). Material y método Se realizó un análisis retrospectivo de 284 pacientes con TVMI tratados con cistectomía radical. Se revisó la analítica preoperatoria y se calcularon índices inmunonutricionales. El método de Kaplan-Meier se utilizó para el cálculo de la SLR. Para el análisis multivariante se utilizó la regresión de Cox. Resultados Mediante análisis univariante se observó una relación estadísticamente significativa con el índice leucocito/linfocito (p = 0,0001), el índice neutrófilo/linfocito (p = 0,02) el índice pronóstico nutricional (p = 0,002), y el ratio plaqueta/linfocito (p = 0,002). En análisis multivariante, el ratio leucocito/linfocito (p = 0,002) y el IPN (p = 0,04) se comportaron como factores pronósticos independientes de disminución de SLR, y se elaboró con ello un score pronóstico que divide a los pacientes en tres grupos pronósticos. El 80% de los pacientes con tumores pT3-4 y/o pN0-1 se encontraban en los grupos de pronóstico medio-malo. Conclusión La incorporación en la práctica clínica de un score inmunonutricional precistectomía ayudaría a seleccionar a un grupo de pacientes con estadio patológico más desfavorable y peor SLR. Creemos que estos pacientes podrían beneficiarse en mayor medida de una QTN (AU)

Introduction Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear. Objective Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1). Material and methods A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan–Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis. Results Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate–poor prognostic groups. Conclusion The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT (AU)

Nefrectomía parcial y radical laparoscópica en tumores renales cT1. Análisis comparativo de complicaciones y supervivencia / Laparoscopic nephron sparing surgery and radical nephrectomy in cT1 renal tumors. Comparative analysis of complications and survival

Introducción y objetivos: Análisis comparativo de complicaciones postoperatorias y supervivencia entre nefrectomía parcial (NP) y radical (NR) laparoscópica en cáncer de células renales (CCR) cT1.Material y método: Estudio retrospectivo de pacientes birrenos con tumor renal único cT1 tratados en nuestro centro entre los años 2005 y 2018 mediante NP o NR laparoscópica.Resultados: Cumplieron los criterios de inclusión para el estudio 372 pacientes. Fueron tratados mediante NR 156 (41,9%) y 216 (58,1%) mediante NP. En 10 (4,6%) NP y 6 (3,9%) NR hubo complicaciones Clavien Dindo III-V (p = 0,75). El índice de comorbilidad de Charlson (ICC) se identificó como variable predictora independiente de complicaciones (p = 0,02), no influyendo el tipo de cirugía en el análisis multivariante. La estimación de la supervivencia global (SG) fue de 81,2 y de 56,8% a los 5 y 10 años en el grupo de NR y de 90,2 y 75,7% en el grupo de NP, respectivamente (p = 0,0001). Se identificaron como factores predictores de mortalidad global la obesidad (HR 2,77, p = 0,01), el ICC ≥ 3 (HR 3,69, p = 0,001) y el FG<60 mL/min/1,73 m2 al alta (HR 1,87,p = 0,03). El tipo de nefrectomía no demostró influencia en la SG. La estimación de la supervivencia libre de recidiva (SLR) fue de 86,1% a los 5 y 10 años en el grupo de NR y de 93,5 y 83,6% en el grupo de NP respectivamente (p = 0,22).Conclusiones: La NP laparoscópica no es inferior a la NR en términos de seguridad oncológica y quirúrgica en el CCR cT1. El tipo de nefrectomía no influyó en la SG del paciente, sin embargo, sí se comportaron como factores predictores la obesidad, el índice Charlson ≥ 3 y el FG<60 mL/min/1,73 m2 al alta (AU)

Introduction and objectives: Comparative analysis of postoperative complications and survival between laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) in cT1 renal cell carcinoma (RCC).Material and method: Retrospective study of patients with two kidneys and single renal tumor cT1 treated in our center between 2005 and 2018 by laparoscopic PN or RN.Results: 372 patients met the inclusion criteria for the study. RN was performed in 156 (41.9%) patients and PN in 216 (58.1%). Clavien Dindo III-V complications were observed in 10 (4,6%) PN and 6 (3,9%) RN patients (p = 0.75). The comorbidity Charlson index (CCI) was identified as an independent predictor variable of complications (p = 0.02) and surgical approach did not affect multivariate analysis. Estimated overall survival (OS) was 81.2% and 56.8% at 5 and 10 years in the RN group and 90.2% and 75.7% in the PN group, respectively (p = 0.0001). Obesity (HR 2.77, p = 0.01), CCI ≥ 3 (HR 3.69, p = 0.001) and glomerular filtration rate (GFR) < 60 mL/min/1.73m2 at discharge (HR 1.87, p = 0.03) were identified as predictors of overall mortality. Nephrectomy approach showed no influence on OS. Estimated recurrence-free survival (RFS) was 86.1% at 5 and 10 years in the RN group and 93.5% and 83.6% in the PN group, respectively (p = 0.22).Conclusions: Laparoscopic PN is not inferior to RN in terms of oncologic and surgical safety in cT1 RCC. Nephrectomy approach did not influence patient OS, however, obesity, CCI ≥ 3 and GFR<60 mL/min/1.73m2 at discharge did behave as predictors (AU)

Laparoscopic nephron sparing surgery and radical nephrectomy in cT1 renal tumors. Comparative analysis of complications and survival.

INTRODUCTION AND OBJECTIVES: Comparative analysis of postoperative complications and survival between laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) in cT1 renal cell carcinoma (RCC). MATERIAL AND METHOD: Retrospective study of patients with two kidneys and single renal tumor cT1 treated in our center between 2005 and 2018 by laparoscopic PN or RN. RESULTS: 372 patients met the inclusion criteria for the study. RN was performed in 156 (41.9%) patients and PN in 216 (58.1%). Clavien Dindo III-V complications were observed in 10 (4,6%) PN and 6 (3,9%) RN patients (p = 0.75). The comorbidity Charlson index (CCI) was identified as an independent predictor variable of complications (p = 0.02) and surgical approach did not affect multivariate analysis. Estimated overall survival (OS) was 81.2% and 56.8% at 5 and 10 years in the RN group and 90.2% and 75.7% in the PN group, respectively (p = 0.0001). Obesity (HR 2.77, p = 0.01), CCI ≥ 3 (HR 3.69, p = 0.001) and glomerular filtration rate (GFR) <60 mL/min/1.73 m2 at discharge (HR 1.87, p = 0.03) were identified as predictors of overall mortality. Nephrectomy approach showed no influence on OS. Estimated recurrence-free survival (RFS) was 86.1% at 5 and 10 years in the RN group and 93.5% and 83.6% in the PN group, respectively (p = 0.22). CONCLUSIONS: Laparoscopic PN is not inferior to RN in terms of oncologic and surgical safety in cT1 RCC. Nephrectomy approach did not influence patient OS, however, obesity, CCI ≥ 3 and GFR <60 mL/min/1.73 m2 at discharge did behave as predictors.

Influence of double J stent in the complications of ureterovesical anastomosis during kidney transplantation.

INTRODUCTION: Complications arising from ureterovesical anastomosis in kidney transplantation have an important influence on the success of the procedure. The most serious and frequent complications are fistula and stenosis of the ureterovesical junction. The placement of double J stents in anastomosis is currently recommended to reduce these complications. OBJECTIVE: The aim of the study is to evaluate whether the placement of a DJ stent affects complications of anastomosis. MATERIAL AND METHODS: Retrospective analysis of 697 patients treated with cadaveric donor renal transplant in our center from 1999 to 2018 was performed. Results were compared according to double J stent placement and the surgical technique employed for anastomosis. RESULTS: Transplantation was performed without DJ placement in 51.7% of the patients, compared to 48.3% who were treated with DJ stent placement. The most commonly used technique was Lich-Gregoir. Ureterovesical fistula occurred in 5% of cases, and ureterovesical stenosis in 4.2%. DJ stent behaved as a protective factor for ureterovesical fistula but did not significantly influence the development of stenosis. The Taguchi technique greatly increased the risk of developing both ureterovesical fistula and stenosis. The incidence of stenosis and fistula was significantly higher when the Taguchi technique was combined with no DJ stent placement. CONCLUSION: DJ stent placement acts as a protective factor for ureterovesical stenosis complications. The results of our study seem to agree with current literature.

Influencia del catéter doble J en las complicaciones de la anastomosis vesicoureteral realizada durante el trasplante renal / Influence of double J stent in the complications of ureterovesical anastomosis during kidney transplantation

Introducción: Las complicaciones surgidas de la anastomosis vesicoureteral en el trasplante renal influyen de forma importante en el éxito del trasplante; siendo las más graves y frecuentes la fístula y la estenosis de la unión ureterovesical. Actualmente se recomienda la colocación de catéteres doble J en esta anastomosis para reducir estas complicaciones.Objetivo: El objetivo del estudio es evaluar si la colocación de un CDJ influye en las complicaciones de esta anastomosis.Material y métodosSe ha realizado un análisis retrospectivo de 697 pacientes tratados con trasplante renal de donante cadáver en nuestro centro desde 1999 hasta 2018; y se ha comparado los resultados en función del uso o no de catéter doble J y la técnica quirúrgica realizada en la anastomosis.Resultados: En el 51,7% de los pacientes no se colocó CDJ; frente a un 48,3% en los que sí se colocó. La técnica más utilizada fue Lich-Gregoir. Se produjo fístula ureterovesical en un 5% de casos, y estenosis ureterovesical en un 4,2%. El CDJ se comportó como factor protector de fístula ureterovesical, pero no influyó significativamente en el desarrollo de estenosis. La técnica de Taguchi multiplicó el riesgo de desarrollar tanto fístula como estenosis ureterovesical. La incidencia de estenosis y de fístula fue significativamente mayor al combinar la técnica de Taguchi con la ausencia de catéter.Conclusión: El CDJ actúa como factor protector para las complicaciones de la estenosis ureterovesical. Los resultados de nuestro estudio parecen ir en concordancia con la literatura actual. (AU)

Introduction: Complications arising from ureterovesical anastomosis in kidney transplantation have an important influence on the success of the procedure. The most serious and frequent complications are fistula and stenosis of the ureterovesical junction. The placement of double J stents in anastomosis is currently recommended to reduce these complications.Objective: The aim of the study is to evaluate whether the placement of a DJ stent affects complications of anastomosis.Material and methodsRetrospective analysis of 697 patients treated with cadaveric donor renal transplant in our center from 1999 to 2018 was performed. Results were compared according to double J stent placement and the surgical technique employed for anastomosis.Results: Transplantation was performed without DJ placement in 51.7% of the patients, compared to 48.3% who were treated with DJ stent placement. The most commonly used technique was Lich-Gregoir. Ureterovesical fistula occurred in 5% of cases, and ureterovesical stenosis in 4.2%. DJ stent behaved as a protective factor for ureterovesical fistula but did not significantly influence the development of stenosis. The Taguchi technique greatly increased the risk of developing both ureterovesical fistula and stenosis. The incidence of stenosis and fistula was significantly higher when the Taguchi technique was combined with no DJ stent placement.Conclusion: DJ stent placement acts as a protective factor for ureterovesical stenosis complications. The results of our study seem to agree with current literature. (AU)

Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía / Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis

INTRODUCCIÓN: Pocos son los estudios que comparan la prostatectomía radical abierta (PRA) con la prostatectomía radical laparoscópica (PRL) y sus resultados funcionales, como la continencia urinaria (CU), que es uno de los objetivos prioritarios tras el control oncológico. OBJETIVOS: Comparar la CU postoperatoria en los pacientes con adenocarcinoma de próstata localizado intervenidos mediante PRA frente a PRL. MATERIAL Y MÉTODOS: Comparación de dos cohortes (312 con PRA y 206 con PRL) entre los años 2007 y 2015. El estado de CU se recogió a los 3, 6, 12, 18 y 24meses. Para el manejo estadístico hemos agrupado la continencia en: a)CU, pacientes que no precisaron absorbentes, y b)incontinencia urinaria (IU), pacientes que precisaron absorbentes. Para el contraste de variables cualitativas se ha utilizado el test de la chi cuadrado para las variables cualitativas y ANOVA para las cuantitativas. Análisis multivariable mediante regresión logística para la variable dependiente IU. La significación estadística se consideró cuando existió una p < 0,05. RESULTADOS: En el 51,7% se realizó conservación neurovascular. A los 24meses de la cirugía, el 72,4% presentaban CU, de los cuales el 87,8% con PRA frente al 78,1% con PRL (p = 0,004). El 22,7% presentaron recidiva bioquímica (RB), siendo el 83% tratados con radioterapia de rescate (RTR). Los pacientes con RTR presentaron mayor porcentaje de IU frente a los que no la recibieron (p = 0,036). Se objetivó mayor porcentaje de estenosis de la anastomosis en PRA (p = 0,03). CONCLUSIONES: La PRL, la no preservación de los fascículos neurovasculares y la RTR se relacionaron directamente con la CU postoperatoria

INTRODUCTION: There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. OBJECTIVES: To compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. MATERIAL AND METHODS: Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007-2015. The UC was evaluated at 3, 6, 12, 18 and 24months. Continence was defined and classified as follows: a)UC, no need of pads, and b)urinary incontinence (UI), use of pads. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when P<.05. RESULTS: Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS: LRP, non-nerve sparing, and SRT were directly related to postoperative UI

Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis. / Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía.

INTRODUCTION: There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. OBJECTIVES: To compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. MATERIAL AND METHODS: Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007-2015. The UC was evaluated at 3, 6, 12, 18 and 24months. Continence was defined and classified as follows: a)UC, no need of pads, and b)urinary incontinence (UI), use of pads. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when P<.05. RESULTS: Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS: LRP, non-nerve sparing, and SRT were directly related to postoperative UI.