Evolución de la función renal en pacientes con cáncer renal cT1 después de nefrectomía parcial y radical laparoscópica. Factores predictores de deterioro de función renal / Evolution of renal function in patients with cT1 renal tumors after laparoscopic partial and radical nephrectomy. Predictive factors for renal function impairment

Introducción y objetivos Analizar la evolución de la función renal tras nefrectomía parcial (NP) y radical (NR) laparoscópica e identificar factores predictores de deterioro de función renal.Material y método Estudio retrospectivo de pacientes birrenos con filtrado glomerular (FG) > 60 mL/min/1,73 m2 y tumor renal único cT1 tratados en nuestro centro entre los años 2005 y 2018.Resultados 372 pacientes cumplieron los criterios de inclusión para el estudio. 156 (41,9%) fueron tratados mediante NR y 216 (58,1%) mediante NP. Al alta hubo una diferencia de 26,75 mL/min/1,73 m2 de FG entre NR y NP. La edad > 60 años, las complicaciones postoperatorias (OR 2,97, p = 0,005) y NR (OR 10,03, p = 0,0001) fueron factores predictores de FG<60 mL/min/1,73 m2 al alta. Únicamente la NR (OR 7,69, p = 0,0001) se comportó como factor pronóstico independiente de FG<45 mL/min/1,73 m2 al alta. La mediana de seguimiento de la serie fue de 57 (IQR 28 - 100) meses. Al final del seguimiento, nueve (6%) pacientes tratados con NR desarrollaron enfermedad renal crónica (ERC) grave y tres (2%) insuficiencia renal terminal (IRT). Edad > 70 años, diabetes mellitus (DM) (HR 2,12, p = 0,001), hipertensión arterial (HTA) (HR 1,73, p = 0,01) y NR (HR 2,88, p = 0,0001) se comportaron como factores predictores independientes de FG<60 mL/min/1,73 m2. Para un FG<45 mL/min/1,73 m2 fueron edad > 70 años, DM (HR 1,99 IC 95% 1,04 a 3,83, p = 0,04) y NR (HR 5,88 IC 95% 2,57 a 13,45, p = 0,0001).Conclusiones La NR es un factor de riesgo a corto y largo plazo de ERC, aunque con baja probabilidad de ERC grave o IRT en pacientes con FG > 60 mL/min/1,73 m2 preoperatoria. La edad, DM e HTA contribuyen al empeoramiento de la función renal durante el seguimiento (AU)

Introduction and objectives To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for deterioration in kidney function.Material and method Retrospective study of patients with two kidneys, glomerular filtration rate (GFR) > 60 mL/min/1.73 m2, and single renal tumor cT1, treated in our center between 2005 and 2018.Results A total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated by RN and 216 (58.1%) by PN. There was a difference of 26.75 mL/min/1.73 m2 in GFR between RN and PN at discharge. Age > 60 years, postoperative complications (OR 2.97, p = 0.005) and RN (OR 10.03, p = 0.0001) were predictors of GFR<60 mL/min/1.73 m2 at discharge. Only RN (OR 7.69, p = 0.0001) behaved as an independent prognostic factor for GFR<45 mL/min/1.73m2 at discharge. The median follow-up of the series was 57 (IQR 28-100) months. At the end of the follow-up period, nine (6%) patients treated with RN developed severe chronic kidney disease (CKD) and three (2%) developed end stage renal disease (ESRD). Age > 70 years, diabetes mellitus (DM) (HR 2.12, p = 0.001), arterial hypertension (AHT) (HR 1.73, p = 0.01) and RN (HR 2.88, p = 0.0001) behaved as independent predictors of GFR<60 mL/min/1.73 m2. The independent predictors for GFR< 45 mL/min/1.73m2 were age >70 years, DM (HR 1.99 CI 95% 1.04-3.83, p = 0.04) and RN (HR 5.88 CI 95% 2.57-13.45, p = 0.0001).Conclusions RN is a short- and long-term risk factor for CKD, although with a low probability of severe CKD or ESRD in patients with preoperative GFR > 60 mL/min/1.73 m2. Age, DM and AHT contribute to worsening renal function during follow-up (AU)

Evolution of renal function in patients with cT1 renal tumors after laparoscopic partial and radical nephrectomy. Predictive factors for renal function impairment.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for renal function impairment. MATERIALS AND METHOD: Retrospective study of patients with two kidneys, glomerular filtration rate (GFR) > 60 mL/min/1.73 m2 and single renal tumor cT1, treated in our center between 2005 and 2018. RESULTS: A total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated with RN and 216 (58.1%) with PN. There was a difference of 26.75 mL/min/1.73 m2 in GFR between RN and PN at discharge. Age >60 years, postoperative complications (OR 2.97, p = 0.005) and RN (OR 10.03, p = 0.0001) were predictors of GFR <60 mL/min/1.73 m2 at discharge. Only RN (OR 7.69, p = 0.0001) behaved as an independent prognostic factor for GFR <45 mL/min/1.73 m2 at discharge. The median follow-up of the series was 57 (IQR 28-100) months. At the end of the follow-up period, nine (6%) patients treated with RN developed severe chronic kidney disease (CKD) and three (2%) developed end stage renal disease (ESRD). Age >70 years, diabetes mellitus (DM) (HR 2.12, p = 0.001), arterial hypertension (AHT) (HR 1.73, p = 0.01) and RN (HR 2.88, p = 0.0001) behaved as independent predictors of GFR <60 mL/min/1.73 m2. The independent predictors for GFR <45 mL/min/1.73 m2 were age >70 years, DM (HR 1.99 CI 95% 1.04-3.83, p = 0.04) and RN (HR 5.88 CI 95% 2.57-13.45, p = 0.0001). CONCLUSIONS: RN is a short- and long-term risk factor for CKD although with a low probability of severe CKD or ESRD in patients with preoperative GFR >60 mL/min/1.73 m2. Age, DM and AHT contribute to worsening renal function during follow-up.

Manejo quirúrgico de tumores en riñón en herradura. Revisión de la literatura y análisis de 2 casos / Surgical management of horseshoe kidney tumors. Literature review and analysis of two cases

Introducción: El riñón en herradura es una anomalía congénita poco frecuente en la población general que combina ectopia renal, malrotación y alteraciones en la vascularización. El tumor que más frecuentemente se desarrolla en estos casos es el carcinoma de células renales (50%).Una de sus características a destacar es la gran variabilidad en su anatomía, sobre todo a nivel vascular.Material y métodosPresentamos 2 casos de pacientes con diagnóstico de tumor renal en riñones en herradura, ambos tratados con nefrectomía parcial laparoscópica, llevados a cabo en nuestro servicio; y realizamos una revisión de la literatura actual.DiscusiónLas indicaciones de tratamiento quirúrgico en tumores en esta enfermedad son las mismas que en los riñones anatómicamente normales. Tradicionalmente, el tratamiento ha sido la cirugía abierta, siendo la heminefrectomía la cirugía de elección. En la actualidad se tiende a defender la cirugía conservadora de nefronas, y el abordaje laparoscópico ha adquirido más importancia progresivamente.ConclusiónEs fundamental realizar un estudio de imagen minucioso para una correcta planificación quirúrgica. (AU)

Introduction: The horseshoe kidney is a rare congenital anomaly in the general population that combines renal ectopia, malrotation and abnormal vascular supply. The most frequently developed tumor in this case is renal cell carcinoma (50%).One of its main characteristics is great anatomical variation, especially in terms of vascular structures.Material and methodsWe present two cases of patients with diagnosis of renal tumor in horseshoe kidneys, both treated with laparoscopic partial nephrectomy in our department. Additionally, we have carried a review of the current literature.DiscussionIndications for surgical treatment in this pathology are the same as in kidneys with normal anatomy. Traditionally, treatment has been open surgery, with heminephrectomy as surgery of choice. The current trend is to advocate nephron-sparing surgery, and the laparoscopic approach has been progressively gaining importance.ConclusionA thorough imaging study is essential for proper surgical planning. (AU)

Evolution of renal function in patients with CT1 renal tumors after laparoscopic partial and radical nephrectomy. Predictive factors for renal function impairment. / Evolución de la función renal en pacientes con cáncer renal cT1 después de nefrectomía parcial y radical laparoscópica. Factores predictores de deterioro de función renal.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for deterioration in kidney function. MATERIALS AND METHOD: Retrospective study of patients with two kidneys, glomerular filtration rate (GFR) > 60 mL/min/1.73 m2, and single renal tumor cT1, treated in our center between 2005 and 2018. RESULTS: A total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated by RN and 216 (58.1%) by PN. There was a difference of 26.75 mL/min/1.73 m2 in GFR between RN and PN at discharge. Age > 60 years, postoperative complications (OR 2.97, p = 0.005) and RN (OR 10.03, p = 0.0001) were predictors of GFR < 60 mL/min/1.73 m2 at discharge. Only RN (OR 7.69, p = 0.0001) behaved as an independent prognostic factor for GFR < 45 mL/min/1.73m2 at discharge. The median follow-up of the series was 57 (IQR 28-100) months. At the end of the follow-up period, nine (6%) patients treated with RN developed severe chronic kidney disease (CKD) and three (2%) developed end stage renal disease (ESRD). Age > 70 years, diabetes mellitus (DM) (HR 2.12, p = 0.001), arterial hypertension (AHT) (HR 1.73, p = 0.01) and RN (HR 2.88, p = 0.0001) behaved as independent predictors of GFR < 60 mL/min/1.73 m2. The independent predictors for GFR< 45 mL/min/1.73m2 were age >70 years, DM (HR 1.99 CI 95% 1.04-3.83, p = 0.04) and RN (HR 5.88 CI 95% 2.57-13.45, p = 0.0001). CONCLUSIONS: RN is a short- and long-term risk factor for CKD, although with a low probability of severe CKD or ESRD in patients with preoperative GFR > 60 mL/min/1.73 m2. Age, DM and AHT contribute to worsening renal function during follow-up.

Surgical management of horseshoe kidney tumors. Literature review and analysis of two cases.

INTRODUCTION: The horseshoe kidney is a rare congenital anomaly in the general population that combines renal ectopia, malrotation and abnormal vascular supply. The most frequently developed tumor in this case is renal cell carcinoma (50%). One of its main characteristics is great anatomical variation, especially in terms of vascular structures. MATERIAL AND METHODS: We present two cases of patients with diagnosis of renal tumor in horseshoe kidneys, both treated with laparoscopic partial nephrectomy in our department. Additionally, we have carried a review of the current literature. DISCUSSION: Indications for surgical treatment in this pathology are the same as in kidneys with normal anatomy. Traditionally, treatment has been open surgery, with heminephrectomy as surgery of choice. The current trend is to advocate nephron-sparing surgery, and the laparoscopic approach has been progressively gaining importance. CONCLUSION: A thorough imaging study is essential for proper surgical planning.

Controversias en el diagnóstico del carcinoma de células renales con trombosis venosa asociada / Controversies in the diagnosis of renal cell carcinoma with tumor thrombus

El diagnóstico y tratamiento del carcinoma de células renales asociado con trombosis venosa tumoral sigue suponiendo un reto en la actualidad, requiriendo de equipos multidisciplinares, fundamentalmente en niveles del trombo III y IV. Nuestro objetivo es la exposición de las distintas técnicas diagnósticas empleadas y de las controversias asociadas. Para ello se ha llevado a cabo una revisión de los artículos relacionados más relevantes entre enero del 2000 y agosto de 2020 en PubMed, EMBASE y Scielo. El continuo desarrollo tecnológico, ha permitido avanzar en su detección, en la aproximación del subtipo histológico y en la determinación del nivel del trombo tumoral. Independientemente de la técnica de imagen utilizada para su diagnóstico (TC, RMN, ETE, ecografía con contraste), es de vital importancia el tiempo transcurrido hasta su tratamiento con el fin de disminuir el riesgo de complicaciones, algunas de ellas fatales como la tromboembolia pulmonar. (AU)

Diagnosis and treatment of renal cell carcinoma with venous tumor thrombosis remains a challenge today, requiring multidisciplinary teams, mainly in tumor thrombus levels III-IV. Our objective is to present the various diagnostic techniques used and its controversies. A review of the most relevant related articles between January 2000 and August 2020 has been carried out in PubMed, EMBASE and Scielo. Continuous technological development has allowed progress in its detection, in the approximation of the histological subtype, and in the determination of tumor thrombus level. Regardless of the imaging technique used for its diagnosis (CT, MRI, TEE, ultrasound with contrast), the time elapsed until treatment is vitally important to reduce the risk of complications, some of them fatal, such as pulmonary thromboembolism. (AU)

Comparación entre prostatectomía laparoscópica y abierta: análisis de la evolución oncológica / Comparison between laparoscopic and open prostatectomy: Oncological progression analysis

INTRODUCCIÓN: Existe muy poca literatura española que compare resultados oncológicos tras prostatectomía radical (PR) según la vía de abordaje y la metodología es inadecuada. OBJETIVO: Comparar los resultados oncológicos en cuanto a márgenes quirúrgicos (MQ) y recidiva bioquímica (RB) entre PR abierta (PRA) y laparoscópica (PRL). MATERIAL Y MÉTODOS: Comparación de 2 cohortes (307 con PRA y 194 con PRL) entre 2007 y 2015. El estado de los MQ se clasificaron como positivos o negativos y la RB como la elevación del PSA después de la PR > 0,4 ng/ml. Para el contraste de variables cualitativas se utilizó el test Chi-cuadrado y ANOVA para las cuantitativas. Para evaluar los factores predictores de los MQ se ha realizado un análisis multivariante mediante regresión logística. Para evaluar los factores predictores de RB se ha realizado un análisis multivariable mediante regresión de Cox. RESULTADOS: El 43,5% de pacientes tuvieron un Gleason 7 (3 + 4) en la pieza quirúrgica y un 31,7% MQ positivos siendo el estadio patológico más frecuente pT2c en el 61,9%. No existieron diferencias significativas entre ambos grupos, excepto la afectación extracapsular (p = 0,001), más frecuente en la PRL. La mediana de seguimiento fue de 49 meses, evidenciando RB en el 23% de pacientes, sin diferencias significativas entre cohortes. En el análisis multivariable solo el grupo de riesgo D'Amico se comportó como factor predictor independiente de MQ positivos y el score de Gleason y los MQ positivos como factores predictores independientes de RB. CONCLUSIÓN: La vía de abordaje no influyó en el estado de MQ ni en la RB

INTRODUCTION: There are very few Spanish studies that compare oncological outcomes following radical prostatectomy (RP) based on surgical approach, and their methodology is not appropriate. OBJECTIVE: To compare oncological outcomes in terms of surgical margins (SM) and biochemical recurrence (BR) between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS: Comparison of two cohorts (307 with ORP and 194 with LRP) between 2007-2015. Surgical margin status was defined as positive or negative, and BR as a PSA rise of > 0.4 ng/ml after surgery. To compare the qualitative variables, we employed the Chi-squared test, and ANOVA was used for quantitative variables. We performed a multivariate analysis using logistic regression to evaluate the predictive factors of SM, and a multivariate analysis using Cox regression to evaluate the predictive factors of BR. RESULTS: Gleason 7 (3 + 4) was determined in the surgical specimens of 43.5% of patients, and 31.7% had positive SM. The most frequent pathological stage was pT2c, on the 61.9% of the cases. No significant differences were found between both groups, except for extracapsular extension (p = 0.001), more frequent in LRP. The median follow-up was 49 months. BR was seen in the 23% of patients, without significant differences between groups. In the multivariable analysis, only the D'Amico risk group behaved as an independent predictive factor of positive SM, and Gleason score and positive SM acted as independent predictive factors of BR. CONCLUSION: The surgical approach did not influence SM status or BR

Comparison between laparoscopic and open prostatectomy: Oncological progression analysis. / Comparación entre prostatectomía laparoscópica y abierta: análisis de la evolución oncológica.

INTRODUCTION: There are very few Spanish studies that compare oncological outcomes following radical prostatectomy (RP) based on surgical approach, and their methodology is not appropriate. OBJECTIVE: To compare oncological outcomes in terms of surgical margins (SM) and biochemical recurrence (BR) between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS: Comparison of two cohorts (307 with ORP and 194 with LRP) between 2007-2015. Surgical margin status was defined as positive or negative, and BR as a PSA rise of >0.4 ng/ml after surgery. To compare the qualitative variables, we employed the Chi-squared test, and ANOVA was used for quantitative variables. We performed a multivariate analysis using logistic regression to evaluate the predictive factors of SM, and a multivariate analysis using Cox regression to evaluate the predictive factors of BR. RESULTS: Gleason 7 (3+4) was determined in the surgical specimens of 43.5% of patients, and 31.7% had positive SM. The most frequent pathological stage was pT2c, on the 61.9% of the cases. No significant differences were found between both groups, except for extracapsular extension (p=0.001), more frequent in LRP. The median follow-up was 49 months. BR was seen in the 23% of patients, without significant differences between groups. In the multivariable analysis, only the D'Amico risk group behaved as an independent predictive factor of positive SM, and Gleason score and positive SM acted as independent predictive factors of BR. CONCLUSION: The surgical approach did not influence SM status or BR.

Controversies in the diagnosis of renal cell carcinoma with tumor thrombus. / Controversias en el diagnóstico del carcinoma de células renales con trombosis venosa asociada.

Diagnosis and treatment of renal cell carcinoma with venous tumor thrombosis remains a challenge today, requiring multidisciplinary teams, mainly in tumor thrombus levels III-IV. Our objective is to present the various diagnostic techniques used and its controversies. A review of the most relevant related articles between January 2000 and August 2020 has been carried out in PubMed, EMBASE and Scielo. Continuous technological development has allowed progress in its detection, in the approximation of the histological subtype, and in the determination of tumor thrombus level. Regardless of the imaging technique used for its diagnosis (CT, MRI, TEE, ultrasound with contrast), the time elapsed until treatment is vitally important to reduce the risk of complications, some of them fatal, such as pulmonary thromboembolism.

Opciones quirúrgicas de implante en pacientes con fibrosis peneana por infección o explantes previos / Surgical implant options in patients with penile fibrosis due to infection or previous explants

La fibrosis peneana por infección y/o explantes de prótesis peneanas previas condiciona situaciones de alta dificultad quirúrgica. El reimplante en estos casos debe seguir un esquema alternativo dirigido a minimizar las complicaciones peri y postoperatorias, así como conseguir la máxima eficacia del procedimiento y la mayor satisfacción postoperatoria del paciente y la pareja. En este artículo se revisan las principales alternativas quirúrgicas en estos casos

Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases

Surgical implant options in patients with penile fibrosis due to infection or previous explants. / Opciones quirúrgicas de implante en pacientes con fibrosis peneana por infección o explantes previos.

Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases.

Clasificación en grupos de riesgo de recurrencia tras nefrectomía por cáncer renal / Recurrence risk groups after nephrectomy for renal cell carcinoma

INTRODUCCIÓN: No existe consenso sobre el seguimiento tras nefrectomía por cáncer renal (CCR), siendo necesario establecer grupos de riesgo de recurrencia (GRR). OBJETIVO: Clasificar en GRR los CCR. MATERIAL Y MÉTODO: Análisis retrospectivo de 696 pacientes con cáncer renal intervenidos entre 1990-2010; 568 (81,6%) pacientes con nefrectomía radical y 128 (18,4%) con nefrectomía parcial. Se clasificaron las variables patológicas como variables de 1. er nivel: estadio pTpN y grado de Fuhrman y variables patológicas de 2. ° nivel (VP2N): diferenciación sarcomatoide (DS), necrosis tumoral (NT), infiltración microvascular y márgenes de resección (MR). Realizamos un análisis multivariante (regresión de Cox) para identificar las variables de 1. er nivel relacionadas con la recurrencia. Clasificamos a los pacientes en 3 GRR según las variables de primer nivel: bajo (GRB) < 25%, intermedio (GRI) 26-50% y alto (GRA) > 50%. Tras ello realizamos un análisis univariante y multivariante con las VP2N para cada GRR. Con estos datos se reclasificaron los pacientes en GRR+. Para la comparación de los GRR con los GRR+ se utilizaron curvas ROC. RESULTADOS: La mediana de seguimiento fue de 105 (IQR 63-148) meses. Recidivaron 177 (25,4%) PACIENTES: 111 (62,7%) con recidiva a distancia, 34 (19,2%) recidiva local y 32 (18%) a distancia y local. Se comportaron como factores predictores independientes de recurrencia el grado de Fuhrman (HR = 2,75; p = 0,0001) y el estadio pTpN (HR = 2,19; p = 0,0001). Se agruparon los pacientes en GRR (ABC = 0,76; p = 0,0001): - GRB (pT1pNx-0 G1-4; pT2pNx-0 G1-2): 456 (65,5%) pacientes. - GRI (pT2pNx-0 G3-4; pT3-4pNx-0 G1-2): 110 (15,8%) pacientes. - GRA (pT3-4pNx-0 G3-4; pT1-4pN+): 130 (18,6%) pacientes. Tras el análisis multivariable con las VP2N, los GRR se reclasificaron (GRR+) (ABC = 0,84; p = 0,0001): -GRB+: GRB sin NT, DS y/o MR(+). -GRI+: GRI; GRB con NT. -GRA+: GRA; GRB con DS y/o MR(+); GRI con NT y/o DS. CONCLUSIONES: La adición de las variables patológicas de segundo nivel a la clasificación, según las variables de primer nivel, mejora la capacidad de discriminación de la clasificación en GRR

INTRODUCTION: There is no consensus on the follow-up protocol after nephrectomy for renal cell carcinoma (RCC), and the identification of recurrence risk groups (RRG) is required. OBJECTIVE: Establish recurrence risk groups (RRG). Material and method: A retrospective analysis of 696 patients with renal cancer submitted to surgery between 1990-2010; 568 (81.6%) patients treated with radical nephrectomy and 128 (18.4%) treated with partial nephrectomy. Pathological variables were classified as: 1st-level variables (1LPV): pTpN stage and Fuhrman grade (FG); and 2nd level pathological variables (2LPV): sarcomatoid differentiation (SD), tumor necrosis (TN), microvascular invasion (MVI) and positive surgical margins (PSM). Univariate and multivariate analysis have been performed using Cox regression to determine 1LPV related to recurrence. Based on 1LPV, we classified patients into three RRG: Low (LRG) < 25%; Intermediate (IRG) 26-50% and High (HRG) > 50%. We performed univariate and multivariate analysis with the 2 LPVs for each RRG. With these data, patients were reclassified as RRG+. ROC curves were used for comparison of RRG and RRG+. RESULTS: The median follow-up was 105 months (range 63 to 148). There were 177 (25.4%) patients with recurrence: 111 (15.9%) distant, 34 (4.9%) local and 32 (4.6%) distant and local. In the multivariable analysis, Fuhrman grade (HR=2,75; P=.0001) and pTpN stage (HR = 2,19; P = .0001) behaved as independent predictive variables of recurrence. Patients were grouped as RRG (AUC = 0,76; p = 0,0001): - LRG (pT1pNx-0 G1-4; pT2pNx-0 G1-2): 456 (65,5%) PATIENTS: - IRG (pT2pNx-0 G3-4; pT3-4pNx-0 G1-2): 110 (15,8%) PATIENTS: - HRG (pT3-4pNx-0 G3-4; pT1-4pN+): 130 (18,6%) PATIENTS: After multivariate analysis with 2LPV, RRG were reclassified (RRG+) (AUC = .84, P = .0001): -LRG+(LRG without TN, SD and/or PSM(+)). -IRG+(IRG; LRG with TN) -HRG+(HRG; LRG with SD and/or PSM(+); IRG with TN and/or SD) CONCLUSIONS: The inclusion of 2LPV to the classification according to VP1N improves the discriminating capacity of RRG classification

Prostatectomía radical laparoscópica frente a prostatectomía radical abierta: comparación del tiempo quirúrgico, complicaciones y estancia postoperatoria / Laparoscopic radical prostatectomy compared to open radical prostatectomy: Comparison between surgical time, complications and length of hospital stay

INTRODUCCIÓN: Existen muy pocos estudios que comparen la prostatectomía radical abierta (PRA) con la prostatectomía radical laparoscópica (PRL). OBJETIVOS: Comparar el tiempo quirúrgico, las complicaciones postoperatorias y la estancia hospitalaria en los pacientes con cáncer de próstata clínicamente localizado tratados mediante PRA y PRL. MATERIAL Y MÉTODOS: Comparación de dos cohortes (312 con PRA y 206 con PRL) entre 2007 y 2015. Las complicaciones postoperatorias se recogieron siguiendo las recomendaciones de las guías clínicas de la EAU y se agruparon según la clasificación de Clavien-Dindo. Para el contraste de variables cualitativas se utilizó el test Chi-cuadrado y ANOVA para las cuantitativas. Análisis multivariable mediante regresión logística para variables dependientes cualitativas y mediante regresión lineal para las variables dependientes continuas. RESULTADOS: La mediana de duración fue de 3:05 horas para la PRA y de 4:35 para la PRL (p = 0,0001). El 26,4% de pacientes presentaron alguna complicación en el postoperatorio. El 31,2% de PRA y el 19,3% de PRL (p = 0,003). La mediana de estancia fue de 4 días. En el grupo de PRA fue de 4 días, mientras que en el de PRL fue de 3 (p = 0,008). La PRL (p = 0,0001), la realización de linfadenectomía (p = 0,02) y la conservación neurovascular (p = 0,01) fueron factores predictores independientes de prolongación del tiempo quirúrgico. La PRL fue un factor protector independiente de complicaciones (OR = 0,48 p = 0,007). El tipo de prostatectomía no influyó en la estancia hospitalaria. CONCLUSIONES: La prostatectomía laparoscópica consumió mayor tiempo quirúrgico, presentó menor porcentaje de complicaciones y no influyó en la estancia hospitalaria

INTRODUCTION: There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). Objetives: To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. MATERIAL AND METHODS: Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. 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 variables and a lineal regression with dependent continuous variables. RESULTS: The mean duration of ORP was 3:05hours and 4:35hours for LRP (p = .0001). The 26.4% of the patients presented any postoperative complication.31.2% of ORP and 19.3% of LRP (p = .003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p = .008). The LRP (p = .0001), lymphadenectomy (p = .02) and nerve-sparing (p = .01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR = 0.48 p = .007). The type of prostatectomy didn't influence in the length of hospital stay. CONCLUSIONS: LRP showed higher surgical time, less complications and it didn't influence the hospital stay

Recurrence risk groups after nephrectomy for renal cell carcinoma. / Clasificación en grupos de riesgo de recurrencia tras nefrectomía por cáncer renal.

INTRODUCTION: There is no consensus on the follow-up protocol after nephrectomy for renal cell carcinoma (RCC), and the identification of recurrence risk groups (RRG) is required. OBJECTIVE: Establish recurrence risk groups (RRG). MATERIAL AND METHOD: A retrospective analysis of 696 patients with renal cancer submitted to surgery between 1990-2010; 568 (81.6%) patients treated with radical nephrectomy and 128 (18.4%) treated with partial nephrectomy. Pathological variables were classified as: 1st-level variables (1LPV): pTpN stage and Fuhrman grade (FG); and 2nd level pathological variables (2LPV): sarcomatoid differentiation (SD), tumor necrosis (TN), microvascular invasion (MVI) and positive surgical margins (PSM). Univariate and multivariate analysis have been performed using Cox regression to determine 1LPV related to recurrence. Based on 1LPV, we classified patients into three RRG: Low (LRG)<25%; Intermediate (IRG) 26-50% and High (HRG)>50%. We performed univariate and multivariate analysis with the 2LPVs for each RRG. With these data, patients were reclassified as RRG+. ROC curves were used for comparison of RRG and RRG+. RESULTS: The median follow-up was 105 months (range 63 to 148). There were 177 (25.4%) patients with recurrence: 111 (15.9%) distant, 34 (4.9%) local and 32 (4.6%) distant and local. In the multivariable analysis, Fuhrman grade (HR=2,75; P=.0001) and pTpN stage (HR=2,19; P=.0001) behaved as independent predictive variables of recurrence. Patients were grouped as RRG (AUC=0,76; p=0,0001): - LRG (pT1pNx-0 G1-4; pT2pNx-0 G1-2): 456 (65,5%) patients. - IRG (pT2pNx-0 G3-4; pT3-4pNx-0 G1-2): 110 (15,8%) patients. - HRG (pT3-4pNx-0 G3-4; pT1-4pN+): 130 (18,6%) patients. After multivariate analysis with 2LPV, RRG were reclassified (RRG+) (AUC=.84, P=.0001): -LRG+(LRG without TN, SD and/or PSM(+)). -IRG+(IRG; LRG with TN) -HRG+(HRG; LRG with SD and/or PSM(+); IRG with TN and/or SD) CONCLUSIONS: The inclusion of 2LPV to the classification according to VP1N improves the discriminating capacity of RRG classification.

Laparoscopic radical prostatectomy compared to open radical prostatectomy: Comparison between surgical time, complications and length of hospital stay. / Prostatectomía radical laparoscópica frente a prostatectomía radical abierta: comparación del tiempo quirúrgico, complicaciones y estancia postoperatoria.

INTRODUCTION: There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). OBJETIVES: To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. MATERIAL AND METHODS: Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. 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 variables and a lineal regression with dependent continuous variables. RESULTS: The mean duration of ORP was 3:05hours and 4:35hours for LRP (p=.0001). The 26.4% of the patients presented any postoperative complication. 31.2% of ORP and 19.3% of LRP (p=.003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p=.008). The LRP (p=.0001), lymphadenectomy (p=.02) and nerve-sparing (p=.01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR=0.48 p=.007). The type of prostatectomy didn't influence in the length of hospital stay. CONCLUSIONS: LRP showed higher surgical time, less complications and it didn't influence the hospital stay.

Diferencias en la supervivencia global y supervivencia cáncer específica en pacientes con cáncer de próstata de alto riesgo según el tratamiento primario aplicado / Differences in overall survival and cancer-specific survival in high-risk prostate cancer patients according to the primary treatment

Introducción y objetivos: No existe evidencia de alto nivel sobre qué tratamiento primario proporciona una ventaja de supervivencia global (SG) y supervivencia cáncer específica(SCE) en cáncer de próstata localizado de alto riesgo (CPAR). Nuestro objetivo es analizar las diferencias en supervivencia, así como sus factores predictores, en este grupo de pacientes según su tratamiento primario (prostatectomía radical [PR] o radioterapia y bloqueo androgénico [RT + HT]). Material y métodos: Estudio retrospectivo de 286 pacientes con CPAR diagnosticados entre 1996-2008, tratados mediante PR (n = 145) o RT+HT (n = 141). La supervivencia se evaluó con el método de Kaplan-Meier. La existencia de diferencias significativas entre las distintas variables se analizó mediante el test de log-rank. Para la identificación de factores de riesgo se utilizó un análisis uni y multivariante mediante regresión de Cox. Resultados: La mediana de seguimiento fue de 117,5 (IQR 87-158) meses. La SG fue mayor (p = 0,04) en los pacientes con PR, mientras que no existieron diferencias (p = 0,44) en la SCE entre ambos grupos. El tipo de tratamiento primario no se relacionó con la SG ni SCE. La edad (p = 0,002), la aparición durante el seguimiento de un segundo tumor (p = 0,0001) y el estadio cT3a (p = 0,009) se comportaron como variables predictoras independientes de SG. Ninguna de las variables se comportó como variable predictora independiente de SCE, aunque la recidiva bioquímica tras tratamiento de rescate (p = 0,058) y la aparición de un segundo tumor durante el seguimiento presentaron una tendencia importante a la significación estadística, reduciendo este último la mortalidad cáncer específica (hazard ratio 0,16, intervalo de confianza del 95% 0,02-1,18, p = 0,07). Conclusiones: El tratamiento primario no se relacionó con la SG ni SCE en pacientes con CPAR

Introduction and objectives: There is no high-level evidence as to which primary treatment provides an overall survival (OS) or cancer-specific survival (CSS) advantage in high-risk localised prostate cancer (HRLPC). Our aim was to analyse the differences in survival and predictive factors in this group of patients, according to their primary treatment (radical prostatectomy (RP) or radiotherapy and androgen blockade (RT + HT)). Material and methods: A retrospective study of 286 HRLPC patients diagnosed between 1996-2008, treated by RP (n = 145) or RT + HT (n = 141). Survival was assessed using the Kaplan-Meier method. Significant differences between the different variables were analysed using the log-rank test. A uni and multivariate Cox regression analysis was performed to identify risk factors. Results: the median follow-up was 117.5 (IQR 87-158) months. The OS was longer (p = .04) in the RP patients, while there were no differences (P=.44) in CSS between either group. The type of primary treatment was not related to OS or CSS. Age (P = .002), the onset during follow-up of a 2 nd tumour (P=.0001), and stage cT3a (P = .009) behaved as independent predictive variables of OS. None of the variables behaved as an independent predictive variable of CSS, although biochemical recurrence after rescue treatment (P = .058), and the onset of a 2nd tumour during follow-up showed a significant trend to statistical significance, the latter reducing specific cancer mortality (HR .16, 95%CI .02-1.18, P = .07)

Differences in overall survival and cancer-specific survival in high-risk prostate cancer patients according to the primary treatment. / Diferencias en la supervivencia global y supervivencia cáncer específica en pacientes con cáncer de próstata de alto riesgo según el tratamiento primario aplicado.

INTRODUCTION AND OBJECTIVES: There is no high-level evidence as to which primary treatment provides an overall survival (OS) or cancer-specific survival (CSS) advantage in high-risk localised prostate cancer (HRLPC). Our aim was to analyse the differences in survival and predictive factors in this group of patients, according to their primary treatment (radical prostatectomy (RP) or radiotherapy and androgen blockade (RT+HT)). MATERIAL AND METHODS: A retrospective study of 286 HRLPC patients diagnosed between 1996-2008, treated by RP (n=145) or RT+HT(n=141). Survival was assessed using the Kaplan-Meier method. Significant differences between the different variables were analysed using the log-rank test. A uni and multivariate Cox regression analysis was performed to identify risk factors. RESULTS: the median follow-up was 117.5 (IQR 87-158) months. The OS was longer (p=.04) in the RP patients, while there were no differences (P=.44) in CSS between either group. The type of primary treatment was not related to OS or CSS. Age (P=.002), the onset during follow-up of a 2nd tumour (P=.0001), and stage cT3a (P=.009) behaved as independent predictive variables of OS. None of the variables behaved as an independent predictive variable of CSS, although biochemical recurrence after rescue treatment (P=.058), and the onset of a 2nd tumour during follow-up showed a significant trend to statistical significance, the latter reducing specific cancer mortality (HR .16, 95%CI .02-1.18, P=.07). CONCLUSIONS: Primary treatment did not relate to OS or CSS in patients with HRPC.