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ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.
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Objective: Describe our experience in laparoscopic urinary undiversion due to recurrent neobladder vaginal fistula (NBVF). Methods: Retrospective review of patients who underwent laparoscopic urinary undiversion. Complications were characterized according to the Clavien classification. The Patient Global Impression of Improvement (PGII) questionnaire was used at one year of follow-up to assess the quality of life (QOL). Results: Three laparoscopic urinary undiversions, from orthotopic neobladder to ileal conduit. Two patients underwent laparoscopic cystectomy due to bladder cancer, and one open pelvic exenteration due to cervical cancer. All patients had received previous pelvic radiotherapy. Complications during the first 2 months were Clavien II (two patients). According to the PGII score, two patients felt "much better" and one felt "very much better." Conclusion: Urinary undiversion is a last resort, complex procedure. Even though, it may be the only chance to improve QOL in patients with recurrent or unrepairable NBVF. A laparoscopic approach with neobladder resection, fistulectomy, and intracorporeal ileal conduit is feasible. Further studies are required to assess the best approach in the management of NBVF.
Objetivo: Describir nuestra experiencia en desderivación urinaria laparoscópica por fístula neo-vesico vaginal recurrente (NBVF). Métodos: Revisión retrospectiva de pacientes a los que se les realizó desderivación urinaria laparoscópica. Las complicaciones se caracterizaron según la clasificación de Clavien. El cuestionario de Impresión Global de Mejora del Paciente (PGII) se utilizó al año de seguimiento para evaluar la calidad de vida (QoL). Resultados: 3 desderivaciones urinarias laparoscópicas, de neovejiga ortotópica a conducto ileal. Dos pacientes se sometieron a cistectomía laparoscópica por cáncer de vejiga y una exenteración pélvica abierta por cáncer de cuello uterino. Todos los pacientes habían recibido radioterapia pélvica previa. Las complicaciones durante los primeros 2 meses fueron Clavien II (2 pacientes). Según la puntuación PGII, dos pacientes se sintieron «Mucho mejor¼ y uno se sintió «Muchísimo mejor.¼ Conclusión: La desderivación urinaria laparoscopica es un procedimiento complejo y de último recurso. Sin embargo, puede ser la única oportunidad para mejorar la calidad de vida en pacientes con NBVF recurrentes o irreparables. El abordaje laparoscópico con resección de neovejiga, fistulectomía y conducto ileal intracorpóreo es factible. Se requieren más estudios para evaluar el mejor enfoque en el manejo de NBVF.
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Humans , FemaleABSTRACT
El conocimiento en cáncer renal ha sido manifiesto en la última década, con adelantos que optimizan el abordaje diagnóstico, quirúrgico y terapéutico con agentes dirigidos contra blancos específicos. El objetivo del trabajo fue la evaluación retrospectiva de pacientes con cáncer de riñón, destacando los datos demográficos, patológicos, quirúrgicos, de recurrencia, así como las modalidades terapéuticas empleadas, y describir la evolución clínica a través de parámetros de eficacia y seguridad. Fueron incluidos 417 pacientes, analizándose los datos de 356. La edad mediana fue de 56 años y 68% eran hombres. El 14% presentó otro tumor primario no renal y 14 desarrollaron otro tumor renal. El diagnóstico fue incidental en el 28% de los casos, la histología más frecuente fue el carcinoma de células claras, el tamaño mediano fue 6.1 cm y en el 20% se observó infiltración capsular. De los 298 pacientes operados, 54% fueron a nefrectomía radical y 26% parcial. El 19% presentaba metástasis al diagnóstico. Recurrencia post-operatoria en 75 de los 298 operados. Los tratamientos más frecuentemente utilizados en primera línea fueron los inhibidores de tirosina-quinasa (55% de los casos) con remisiones del 43-50% y un tiempo a la progresión de 12.1 meses. La revisión retrospectiva de los datos en cáncer renal de una población académica que incorpora la metodología diagnóstica, quirúrgica y terapéutica en enfermedad localizada y avanzada, permite reproducir los datos que surgen de países centrales y de estudios clínicos aleatorizados (AU)
Improving knowledge in renal cancer has been successful in the last decade in terms of diagnosis, surgical and therapeutic approach with targeted agents. The objective of the study was the retrospective evaluation of patients with kidney cancer, emphasizing recurrence as well as therapeutic modalities, pathological and surgical, demographic data and to describe outcome through efficacy and safety parameters. There were included 417 patients. The median age was of 56 years and 68% were men. There was a 14% of patients with another non-renal primary tumor and 14 patients developed another kidney tumor. The diagnosis was incidental in 28% of cases. The most common histology was clear cell carcinoma, medium size was 6.1 cm and capsular infiltration was observed in 20%. Of the 298 patients operated, 54% were to radical nephrectomy and 26% partial. The 19% of the patients had metastases from diagnosis. Post-operative recurrence was developed in 75 of 298 surgical patients. The most frequent systemic first line therapy was tyrosine-kinase inhibitors (55% of cases) with remissions of 43-50% and time to progression was 12.1 months. The retrospective review in renal cancer of an academic population gives the rationale of data of the real world and to compare with those that arise from central countries and randomized clinical trials (AU)