Resultados peri-operatórios da nefrectomia parcial aberta, vídeolaparoscópica e robótica no tratamento do tumor renal em um centro de referência no tratamento do câncer / Perioperative outcomes in open, laparoscopic and robot-assisted partial nephrectomy for renal tumor treatment from a Cancer Center

Introdução: A nefrectomia parcial (NP) é considerada atualmente o padrão ouro no tratamento das pequenas massas renais (PMR) estádio clínico T1a. Poucos são os estudos disponíveis que comparam os resultados peri-operatórios das nefrectomias parciais aberta (NPA), vídeo-laparoscópica (NPVL) e robô-assistida (NPR) no tratamento das PMR. Objetivo: Avaliamos e comparamos os resultados peri-operatórios da NP realizada por três diferentes vias: NPA, NPVL e NPR no tratamento das PMR. Material e Método: Os dados peri-operatórios dos pacientes com tumor renal e submetidos à NP no período de maio de 2013 a maio de 2016 no Núcleo de Urologia do A.C.Camargo Cancer Center foram, retrospectivamente, coletados e avaliados. Os dados cirúrgicos foram comparados segundo a técnica cirúrgica empregada. Resultados: Trezentos e noventa NP foram revistas: 59 NPA, 251 NPVL e 80 NPR. Seguem resultados (média) comparativos entre NPA, NPVL e NPR, respectivamente: tamanho do tumor (3.73, 2.68 e 3.99cm), p=0.011; tempo de cirurgia (209, 189 e 159 min), p=0.012; tempo de isquemia (14.87, 15,83 e 9.98 min), p= 0.001; transfusão sanguínea (33.9, 29.1 e 40%), p=0.184; volume de transfusão sanguínea (3.3, 1.02 e 0.95 concentrado de hemácias), p= 0.018; taxa de conversão para cirurgia aberta (0, 4.8 e 1.25%), p=0.038; margem cirúrgica positiva (5.2, 6.5 e 2.5%), p=0.407; complicações precoces e tardias (13.56 e 10.17, 7.17 e 9.56 e 16.25% e 8.75%), p=0.038 e p=0.959; gravidade das complicações >III ­ Clavien-Dindo (0, 7.2 e 3.8%), p=0.003; Hb pré e pós operatório (13.63 e 11.44; 14.25 e 13.13 e 14.39 g/dl e 13.80 g/dl), p= 0.066 e p= 0.083; creatinina pré e pós-operatório (1.37 e 0.97, 1.02 e 1.04 e 0.95 mg/dl e 1.09 mg/dl), p=0.281 e p=0.198; dias de internação (9.29, 3.45 e 3.79 dias), p= 0.000. Conclusão: A escolha do tipo de abordagem cirúrgica no tratamento do tumor renal T1a-T2a afetou os resultados peri-operatórios dos pacientes: a NPR foi a técnica utilizada na abordagem dos tumores de maior tamanho, apresentou menores tempos de cirurgia e isquemia, em relação à NPA e NPVL, e apresentou menor taxa de conversão para cirurgia aberta, em relação à NPVL; a NPVL apresentou complicações de maior gravidade, segundo classificação de Clavien-Dindo, e menor taxa de complicações precoces em relação à NPA e NPR e a NPA apresentou maior necessidade de concentrado de hemácias nas transfusões sanguíneas realizadas e maior tempo de internação hospitalar em relação à NPVL e NPR

Introduction: Partial nephrectomy (PN) is the gold standard treatment for slow renal masses (SRM), clinical T1a renal tumors. Comparison of PN perioperative outcomes in the treatment of SRM are limited. Purpose: We evaluated and compared the A.C.Camargo Cancer Center surgical perioperative outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN) and robotic partial nephrectomy (RPN) in the treatment of SRM. Material and method: The data of patients undergoing PN at A.C.Camargo Cancer Center Urology Service were retrospectively collected and analyzed. Were compared the surgical outcomes as the three different approaches: OPN, LPN and RPN. Results: Three hundred and ninety procedures were reviewed: 59 OPN, 251 LPN and 80 RPN. The comparative results (median) as OPN, LPN and RPN were, respectively: tumor size (3.73, 2.68 and 3.99 cm), p=0.011; operative time (209, 189 and 159 min), p=0.012; ischemia time (14.87, 15,83 and 9.98 min), p= 0.001; blood transfusion (33.9, 29.1 and 40%), p=0.184; blood transfusion volume (3.3, 1.02 and 0.95 red cells concentrate unit), p= 0.018; conversion to open surgery (0, 4.8 and 1.25%), p=0.038; positive surgical margin (5.2, 6.5 and 2.5%), p=0.407; postoperative complications: early and late (13.56 and 10.17, 7.17 and 9.56 and 16.25% and 8.75%), p=0.038 and p=0.959; Clavien Grade complications ≥ III (0, 7.2 and 3.8%), p=0.003; Hemoglobin before and after surgery (13.63 and 11.44; 14.25 and 13.13 and 14.39 g/dl and 13.80 g/dl), p= 0.066 and p= 0.083; Creatinine before and after surgery ( 1.37 and 0.97, 1.02 and 1.04 and 0.95 mg/dl and 1.09 mg/dl), p=0.281 and p=0.198; hospital stay (9.29, 3.45 and 3.79 days), p= 0.000. Conclusion: The surgical approach for clinical T1a-T2a renal tumors treatments affected the perioperative outcomes: RPN was the approach used for bigger tumors, had shorter operative and ischemia times as compared to LPN and OPN; RPN had lower risk of conversion to open surgery as compared to LPN. Clavien Grade ≥ III and less early postoperative complications were found in the LPN group as compared to OPN and RPN. Longer hospital stay and more blood volume need in the transfusions were found in the OPN group

Carcinoma of the renal pelvis and ureter

OBJECTIVE: To assess the occurrence of upper urinary tract urothelial tumors (UUTT) in Brazil. MATERIALS AND METHODS: We performed a clinical and histopathologic study of 33 patients who were diagnosed with a malignant neoplasm in the renal pelvis or ureter in the period of 1994 to 2004, in a single institution. RESULTS: Among the patients with upper urinary tract carcinoma, 70 percent were males and 30 percent females, with mean age of 65 ± 16 years (ranging from 31 to 91 years). Nineteen patients presented renal pelvis tumor (58 percent), 9 ureteral tumor (27 percent) and 5 synchronic pelvic and ureteral tumors (15 percent). Renal pelvis tumors represented 2.8 percent of all the urothelial neoplasms, and 11.4 percent of all renal neoplasms treated in the same period. Ureteral tumors represented 1.6 percent of all the urothelial malignancies surgically managed in these 11 years. Tobacco smoking was the most common risk factor, and analgesic abuse was not reported by those patients. Most carcinomas were high-grade and muscle-invasive. Mean time to diagnosis was 7 months, being hematuria the most common symptom. CONCLUSIONS: A high association was also found between UUTT and bladder urothelial carcinoma. UUTT were mostly seen in men in their seventies and related to a high overall and cancer-related mortality rate. The overall disease-specific survival was 40 percent, much lower than found in most of the reported series.