Características Clínicas dos Pacientes Submetidos à Nefrectomia Parcial e Presença de Carcinoma Renal / Clinical Characteristics of Patients Undergoing Partial Nephrectomy and the Occurrence of Renal Carcinoma / Características Clínicas de Pacientes con Nefrectomía Parcial y Presencia de Renal Carcinoma

Introdução: Existem poucos relatos correlacionando dados clínicos com a presença de carcinoma renal após o diagnóstico do tumor no exame de imagem. Objetivos: Analisar as características clínicas de pacientes submetidos à nefrectomia parcial (NP); correlacionar dados clínicos e da evolução no pós-operatório com a presença de carcinomas renais. Método: Estudo clínico observacional, retrospectivo, com 178 pacientes submetidos à NP entre 2009 a 2013. Foram avaliadas as características demográficas; morbidades: diabetes mellitus, hipertensão, doença cardiovascular; complicações do intra e pós-operatório e evolução. Os dados foram descritos em porcentagens, médias e desvio-padrão e significância estatística se p<0,05. Resultados: Foram analisados 178 pacientes de 54,0±13,4 anos, 61,2% do sexo masculino, 18,6% com tumores benignos e 81,4% com carcinomas renais. Entre os carcinomas, 69,7% foram de células claras e, entre os tumores benignos, 72,7% eram oncocitomas. A NP aberta foi realizada em 55,9% das vezes e em 44,1% por via laparoscópica. Após a cirurgia, 31,4 % necessitaram de unidade de terapia intensiva; 13,4 % apresentaram lesão renal aguda; 2,3 % alguma infecção; e 1,8% (n=3) foram a óbito após a alta. Entre as características, somente a obesidade e a redução do ritmo de filtração glomerular estimado (eRFG) em sete dias foi significativamente maior nos pacientes com carcinomas. Conclusões: Pacientes submetidos à NP eram predominantemente do sexo masculino e portadores de carcinomas de células claras. Pacientes com carcinomas eram mais obesos e tiveram maior redução do eRFG em sete dias do pós-operatório

Introduction: There are few reports correlating clinical data with renal carcinoma after the diagnosis of the tumor in the imaging examination. Objectives: To analyze the clinical characteristics of patients submitted to partial nephrectomy (PN); to correlate clinical and evolution data in the postoperative period with the presence of renal carcinomas. Method: A retrospective, observational clinical study, with 178 patients undergoing to PN between 2009 and 2013. Demographic characteristics were assessed; Morbidities: diabetes mellitus, hypertension, cardiovascular disease; intra and postoperative period complications and evolution. Data were described in percentages, means and standard deviation, and statistical significante if p<0.05. Results: 178 patients, 54.0 ± 13.4 years old, 61.2% male, 18.6% with benign tumors and 81.4% with renal carcinomas were analyzed. Among the carcinomas, 69.7% were Clear Cells and among the benign tumors 72.7% were oncocytomas. Open PN was performed in 55.9% and 44.1 laparoscopy. After surgery: 31.4% needed intensive care unit, 13.4% presented acute renal injury; 2.3% some infection and 1.8% (n=3) died after discharge. Among the characteristics only obesity and reduction of estimated glomerular filtration rate (eRFG) in seven days was significantly higher in patients with carcinomas. Conclusion: Patients submitted to PN were predominantly male and had clear cell carcinomas. Patients with carcinomas were more obese and had greater reduction of eRFG within seven days of postoperative period.

Introducción: Hay pocos informes que correlacionan los datos clínicos con la presencia de un carcinoma renal después del diagnóstico de imágenes de tumores. Objetivos: Analizar las características clínicas de los pacientes sometidos a nefrectomía parcial (NP); correlacionar datos clínicos y de la evolución en el postoperatorio con la presencia de carcinomas renales. Método: Estudio observacional clínico, retrospectivo, con 178 pacientes sometidos a NP entre 2009 y 2013. Fueran evaluadas las características demográficas; morbilidades: diabetes mellitus, la hipertensión, enfermedades cardiovasculares; complicaciones de intraoperatorio y postoperatorio. Los datos se presentan en porcentajes, medias y desviaciones estándar, y significancia estadística si p<0,05. Resultados: 178 pacientes analizadas con respecto a 54,0 ± 13,4 años 61,2% varones, 18,6% con tumores benignos y 81,4% con carcinomas renales. Entre los carcinomas, 69,7% eran células claras y entre tumores benignos 72,7% eran oncocitomas. NP abierta se realizó en 55,9% y 44,1% laparoscópica. Después de la cirugía: 31,4% unidad de terapia intensiva es necesario, 13,4% tenían una lesión renal aguda; 2,3% una infección y 1,8% (n=3) murieron después de la descarga. Entre las características, la obesidad y la reducción del ritmo de filtración glomerular estimado (eRFG) en siete días fue mayor significativamente en los pacientes con carcinoma. Conclusión: Los pacientes sometidos a NP, principalmente varones, los pacientes con carcinomas de células claras. Los pacientes con carcinomas eran más obesos y tenían una mayor reducción en eRFG siete días apartado de correos.

Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with endometrial cancer: a systematic review and meta-analysis / 부인종양

OBJECTIVE: To compare the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for detecting myometrial infiltration (MI) in endometrial carcinoma. METHODS: An extensive search of papers comparing TVS and MRI in assessing MI in endometrial cancer was performed in MEDLINE (PubMed), Web of Science, and Cochrane Database from January 1989 to January 2017. Quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS: Our extended search identified 747 citations but after exclusions we finally included in the meta-analysis 8 articles. The risk of bias for most studies was low for most 4 domains assessed in QUADAS-2. Overall, pooled estimated sensitivity and specificity for diagnosing deep MI were 75% (95% confidence interval [CI]=67%–82%) and 82% (95% CI=75%–93%) for TVS, and 83% (95% CI=76%–89%) and 82% (95% CI=72%–89%) for MRI, respectively. No statistical differences were found when comparing both methods (p=0.314). Heterogeneity was low for sensitivity and high for specificity for TVS and MRI. CONCLUSION: MRI showed a better sensitivity than TVS for detecting deep MI in women with endometrial cancer. However, the difference observed was not statistically significant.