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)

Valoración de las vías de abordaje al riñon en relación al compromiso neuromuscular / Evaluation of the approach routes to kidney regarding the neuromuscular involvement

Se trata de un ejercicio clínico-quirúrgico durante el cual el cirujano, autocriticamente, ensayó y analizó más de 30 incisiones y vías de abordaje, para valorar el diferente compromiso neuromuscular en cirugía renal. Para evaluación de secuelas posquirúrgicas se asoció equilibradamente clínica con EMG regladas. Así sintetizamos como propuesta general, optar por incisiones mínimas, compatibles con la visualización requerida en cada caso, paralelas a las fibras musculares y luego divulsión para ampliar campo. Como conducta fisiátrica de apoyo, ofrecemos un esquema fisiokinésico original, con dos objetivos sincrónicos: resolución dinámica y temprana de las secuelas ya instaladas y prevención de las complicaciones típicas en cirugía renal

Cirugía de rescate en cáncer de testículo / Ranson surgery in testicular neoplasm

Se presentan datos sobre 16 cirugías de rescate en 15 pacientes portadores de tumor de testículo avanzado. Se evalúan los datos de estadificación, evolución y seguimiento. Se efectúan consideraciones sobre la táctica quirúrgica realizada, los hallazgos operatorios y la histología de las piezas resecadas, valorando además la utilidad de los exámenes complementarios

Tumor hamartomatoso del epidídimo: comunicación de un caso / Hamartomatious tumor of the epididymis: report of a case

Se presenta un caso de tumor adenomatoide del epidídimo. Se resalta la rareza del tumor. Se hacen consideraciones sobre la histogénesis y nomenclatura de la lesión