Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group.

BACKGROUND: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. OBJECTIVE: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. METHODS: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (less than 75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. RESULTS: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 0.01) and higher ASA score (ASA > 2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. CONCLUSIONS: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

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.

La elevación de los índices preoperatorios de neutrófilos/linfocitos y de plaquetas/linfocitos se asocia a una mayor agresividad local en los tumores renales / Elevation of Preoperative Neutrophil-Lymphocyte ratio and Platelet-Lymphocyte ratio is associated with a Higher Tumor Aggressiveness in Kidney Cancer

Introducción: Existe evidencia de que los índices de neutrófilos/linfocitos (INL) y plaquetas/linfocitos (IPL) se asocian a un peor pronóstico oncológico en distintas enfermedades neoplásicas. El objetivo de este trabajo es analizar la asociación entre el INL y el IPL preoperatorio y la agresividad local del tumor en el carcinoma de células renales (CCR). Materiales y métodos: Se analizaron el INL y el IPL de 353 pacientes que fueron tratados por CCR, sin enfermedad a distancia, entre enero de 2010 y julio de 2013. Se utilizó la regresión de Cox para estimar la asociación entre ambos índices y el estadío patológico, el grado histológico de Fuhrman/ISUP (International Society of Urological Pathology) y la progresión de la enfermedad. Resultados: La mitad de los pacientes presentó grado ISUP III o IV; 24 pacientes presentaron estadío patológico pT3a o superior. En total, 12 pacientes presentaron recidiva local y 19 presentaron metástasis. En el análisis multivariado, un mayor INL o IPL se asoció a un mayor grado ISUP y estadío patológico avanzado. Las medias de INL e IPL fueron significativamente superiores en los pacientes con grado Fuhrman/ ISUP IV y estadío pT3a o superior (p<0,05). El grado ISUP IV y el estadío pT3b se asociaron significativamente a la progresión de la enfermedad, mientras que el INL y el IPL no lo hicieron. Conclusión: La elevación de INL e IPL se asocia a una mayor agresividad local en el CCR, lo que se manifiesta por tumores con un mayor grado de Fuhrman/ISUP o un estadío localmente avanzado. Evaluar estos cocientes antes de la nefrectomía puede brindarle al cirujano un elemento más para conocer el tipo de tumor al que se enfrenta y programar una estrategia acorde.(AU)

Introduction: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with tumor progression and worse oncologic outcomes in different neoplastic diseases. The aim of this study is to analyze the association between preoperative NLR and PLR and local tumor aggressiveness in renal cell carcinomas (RCC). Materials and methods: Pre-treatment NLR and PLR were analyzed in 353 patients who underwent treatment for non-metastatic RCC. Cox regression was used to estimate the association between NLR and PLR with pathological stage (pT), International Society of Urological Pathology (ISUP) grade, and disease progression. Results: ISUP grades III or IV were found in 50% of patients; 24 patients had pT3a stage or higher. After the surgery, 12 patients presented a local relapse, and 19 presented metastases. On multivariable analysis, higher NLR and PLR were significantly associated with a higher ISUP grade and advanced pT stage. Mean NLR and PLR were significantly higher in patients with Fuhrman/ISUP grade IV and pT3a or higher stage (p<0.05). ISUP grade IV and stage pT3b or higher both were associated with disease progression, while NLR and PLR weren't. Conclusion: Elevation of preoperative NLR and PLR is associated with a higher tumor aggressiveness in RCC. Higher ratios are significantly associated with ISUP grade IV and locally advanced stage (pT3b or higher). The preoperative evaluation of these ratios may give the surgeon another element to evaluate the type of tumor he is facing and adopt the best strategy. (AU)

Proteína C reactiva ultrasensible como variable predictora de carcinoma renal localmente avanzado / High-sensitivity c-reactive protein as a predictor of locally advanced renal cell carcinoma

OBJETIVO: Determinar si valores elevados de proteína C reactiva ultrasensible plasmática (PCRu) se asocian a la presencia de enfermedad renal localmente avanzada (ERLA) en pacientes con sospecha de carcinoma de células renales intervenidos quirúrgicamente. MÉTODOS: Estudio retrospectivo de tipo transversal entre Mayo de 2009 y Enero de 2011. Fueron evaluados 192 pacientes con sospecha de carcinoma de células renales no metastásico, que tuvieran cuantificación preoperatoria de la PCRu. Se evaluó la relación entre edad, sexo, tabaquismo, síntomas y PCRu mayor a 10 mg/l, con ERLA. Para la comparación de variables categóricas se utilizó test de chi2 y test de Fisher. Se emplearon métodos de regresión logística ajustada por variables de significancia biológica para el análisis multivariado. RESULTADOS: La mediana de la edad fue de 62 años (r=23 a 85), 72.4% masculinos. La mediana de la PCRu fue de 2.40mg/l (r=0.1 a 173). El 43.2% de los pacientes tenían antecedentes de tabaquismo y el 81.8% de los pacientes fueron asintomáticos. El 77.1% de los tumores correspondieron a carcinoma de células claras, 14.6% cromófobo, 4.7% papilar, 2.6% oncocitomas, 1% otras variedades de carcinomas renales. En cuanto a la clasificación TNM, el 45,8% de los casos correspondió al estadio pT1a , el pT1b en el 27.6% de los casos, el pT2 en el 13% y el pT3 en el 13.5%. No se halló pT4.En el análisis multivariado, la presencia de síntomas (p=0.002 OR=3.1 con un IC 95% 1.2-8.1) y la presencia de PCRu mayor a 10 mg/l (p=0.006 OR=4 con un IC 95% 1.5-10.8) se mantuvieron como variables predictoras de ERLA. CONCLUSIONES: Valores plasmáticos de PCRu mayores a 10 mg/l aumentan 4 veces las posibilidades de encontrar ERLA en la anatomía patológica. Esta variable debería ser tenida en cuenta a la hora de indicar el mejor tratamiento para el carcinoma de células renales(AU)

OBJECTIVES: To determine if elevated levels of high-sensitivity C-reactive protein (CRP) in plasma are associated with locally advanced renal cell carcinoma (LARCC) after surgery. METHODS: Retrospective cross-sectional study conducted from May 2009 to January 2011. Altogether, 192 patients with non-disseminated disease and with preoperative quantitative determination of the CRP were evaluated. We evaluated the relation between age, gender, history of smoking, symptoms and CRP higher than 10 mg/L, with LARCC. The chi-square and Fisher’s tests were used to compare categorical variables. For the multivariate analysis, we used logistic regression methods. RESULTS: The median age was 62 years (r=23-85), 72.4% were males. The median CRP was 2.40 mg/L (r=0.1-173). Of all the patients, 43.2% had a history of smoking and 81.8% were asymptomatic. As for the tumors, 77.1% were clear cell carcinoma, 14.6% chromophobe, 4.7% papillary, 2.6% oncocytomas, and 1% other varieties of renal cell carcinoma. As for the TNM classification, 45.8% corresponded to stage pT1a, 27.6% pT1b, 13% pT2, and 13.5% pT3, pT4 was not found. In the multivariate analysis, the presence of symptoms (p=0.002, OR=3.1) and the presence of CRP higher than 10 mg/L (p=0.006, OR=4) remained as the only prognostic variables of LARCC. CONCLUSIONS: Values of CRP higher than 10 mg/L increase 4 times the possibilities of finding LARCC in the pathological study of the surgical specimen. This variable should be taken into account when deciding what is the best surgical option(AU)

High-sensitivity C-reactive protein as a predictor of locally advanced renal cell carcinoma.

OBJECTIVES: To determine if elevated levels of high-sensitivity C-reactive protein (CRP) in plasma are associated with locally advanced renal cell carcinoma (LARCC) after surgery. METHODS: Retrospective cross-sectional study conducted from May 2009 to January 2011. Altogether, 192 patients with non-disseminated disease and with preoperative quantitative determination of the CRP were evaluated. We evaluated the relation between age, gender, history of smoking, symptoms and CRP higher than 10 mg/L, with LARCC. The chi-square and Fisher's tests were used to compare categorical variables. For the multivariate analysis, we used logistic regression methods. RESULTS: The median age was 62 years (r=23-85), 72.4% were males. The median CRP was 2.40 mg/L (r=0.1-173). Of all the patients, 43.2% had a history of smoking and 81.8% were asymptomatic. As for the tumors, 77.1%were clear cell carcinoma, 14.6% chromophobe, 4.7% papillary, 2.6% oncocytomas, and 1% other varieties of renal cell carcinoma. As for the TNM classification, 45.8% corresponded to stage pT1a, 27.6% pT1b, 13% pT2, and 13.5% pT3, pT4 was not found. In the multivariate analysis, the presence of symptoms (p=0.002, OR=3.1) and the presence of CRP higher than 10 mg/L (p=0.006, OR=4) remained as the only prognostic variables of LARCC. CONCLUSIONS: Values of CRP higher than 10 mg/L increase 4 times the possibilities of finding LARCC in the pathological study of the surgical specimen. This variable should be taken into account when deciding what is the best surgical option.