Nefrectomía parcial robótica en 95 pacientes consecutivos: resultados oncológicos y funcionales a 3 años de seguimiento / Robot-assisted partial nephrectomy in 95 consecutive patients: Oncological and functional outcomes at 3 years of follow-up

Introducción: Presentamos los resultados oncológicos y funcionales de una serie de 43 pacientes afectos de un tumor renal, tratados en forma consecutiva mediante nefrectomía parcial robótica (NPR). Material y método: Entre los años 2010 y 2014 efectuamos 95 NPR. Para la evaluación de los resultados se incluyeron solo a los pacientes (n = 43) que tuvieran un seguimiento mínimo de 2 años. Se realizó un análisis descriptivo de las características demográficas y variables perioperatorias. Se utilizaron curvas de Kaplan-Meier para evaluar la supervivencia global, supervivencia cáncer-específica y supervivencia libre de recurrencia. Resultados: La edad media fue 53,1 ± 13,5 años. El tamaño tumoral preoperatorio fue 3,7 ± 2,3 cm. El tiempo quirúrgico fue 102,2 ± 37,1 min. El tiempo de isquemia fue de 21,27 ± 7,74 min con una mediana de sangrado intraoperatorio de 150 ml (RIC = 87,5-425). Hubo un 7% de complicaciones postoperatorias Clavien ≥ III. No hubo mortalidad. El grado de Fürhman promedio fue 2,5 ± 0,56. No hubo márgenes quirúrgicos positivos ni recurrencia local. La mediana de seguimiento fue 38 ± 8 meses, con una supervivencia global, una supervivencia libre de recurrencia y una supervivencia cáncer específica del 100% a 3 años de seguimiento. La supervivencia libre de recurrencia fue del 92,3% a 48 meses de seguimiento. La media de filtración glomerular preoperatoria fue 91,04 ± 28,17 y la postoperatoria 89,9 ± 27,69 ml/min por 1,73 m2, con una disminución no significativa (p = 0,74). Conclusiones: Los resultados funcionales y oncológicos de nuestra serie de NPR, confirman su seguridad y eficacia. La NPR ofrece una óptima preservación de la función renal y control oncológico a mediano plazo

Background: We present the oncological and functional results from a series of 43 patients with renal tumours, treated consecutively with robot-assisted partial nephrectomy (RPN). Materials and method: Between 2010 and 2014, we performed 95 RPNs. To assess the results, we included only those patients (n = 43) who had a minimum follow-up of 2 years. A descriptive analysis was conducted of the demographic characteristics and perioperative variables. We employed Kaplan-Meier curves to assess overall survival, cancer-specific survival and recurrence-free survival. Results: The patients’ mean age was 53.1 ± 13.5 years. The mean preoperative tumour size was 3.7 ± 2.3 cm. The mean surgical time was 102.2 ± 37.1 min. The mean ischemia time was 21.27 ± 7.74 minutes, with a median intraoperative bleeding volume of 150 mL (IQR, 87.5-425). There was a 7% rate of postoperative complications (Clavien ≥ III). There was no mortality. The average Fürhman grade was 2.5 ± 0.56. There were no positive surgical margins or local recurrences. The median follow-up was 38 ± 8 months, with an overal survival, recurrence-free survival and cancer-specific survival of 100% at 3 years of follow-up. The recurrence-free survival was 92,3% at 48 months of follow-up. The mean preoperative glomerular filtration rate was 91.04 ± 28.17 mL/min/1.73 m2, and the postoperative rate was 89.9 ± 27.69 mL/min/1.73 m2, with a nonsignificant reduction (P = .74). Conclusions: The functional and oncological results of our series confirm the safety and efficacy of RPN. RPN offers optimal preservation of renal function and oncological control in the medium term

Robot-assisted partial nephrectomy in 95 consecutive patients: Oncological and functional outcomes at 3 years of follow-up. / Nefrectomía parcial robótica en 95 pacientes consecutivos: resultados oncológicos y funcionales a 3 años de seguimiento.

BACKGROUND: We present the oncological and functional results from a series of 43 patients with renal tumours, treated consecutively with robot-assisted partial nephrectomy (RPN). MATERIALS AND METHOD: Between 2010 and 2014, we performed 95 RPNs. To assess the results, we included only those patients (n=43) who had a minimum follow-up of 2 years. A descriptive analysis was conducted of the demographic characteristics and perioperative variables. We employed Kaplan-Meier curves to assess overall survival, cancer-specific survival and recurrence-free survival. RESULTS: The patients' mean age was 53.1±13.5 years. The mean preoperative tumour size was 3.7±2.3cm. The mean surgical time was 102.2±37.1min. The mean ischemia time was 21.27±7.74minutes, with a median intraoperative bleeding volume of 150mL (IQR, 87.5-425). There was a 7% rate of postoperative complications (Clavien≥III). There was no mortality. The average Fürhman grade was 2.5±0.56. There were no positive surgical margins or local recurrences. The median follow-up was 38±8 months, with an overal survival, recurrence-free survival and cancer-specific survival of 100% at 3 years of follow-up. The recurrence-free survival was 92,3% at 48 months of follow-up. The mean preoperative glomerular filtration rate was 91.04±28.17mL/min/1.73m(2), and the postoperative rate was 89.9±27.69mL/min/1.73m(2), with a nonsignificant reduction (P=.74). CONCLUSIONS: The functional and oncological results of our series confirm the safety and efficacy of RPN. RPN offers optimal preservation of renal function and oncological control in the medium term.

Descripción y evaluación estandarizada de complicaciones asociadas a adrenalectomía laparoscópica / Complications associated with laparoscopic adrenalectomy: Description and standardized assessment

Objetivo: La adrenalectomía laparoscópica (AL) es el procedimiento de elección para el manejo quirúrgico de las masas adrenales. Nuestro objetivo es presentar una evaluación estandarizada de las complicaciones perioperatorias en una serie de AL. Material y métodos: Entre los meses de junio de 1993 a septiembre de 2012 se realizaron 344 AL en pacientes con diagnóstico de tumor suprarrenal, de forma consecutiva. Los datos fueron recolectados de forma prospectiva y analizados retrospectivamente para evaluar las complicaciones perioperatorias. Las complicaciones intraoperatorias se definieron utilizando la clasificación de Satava y las complicaciones postoperatorias según la clasificación de Clavien-Dindo. Resultados: Veinticinco AL presentaron complicaciones perioperatorias (7,3%), 11 fueron intraoperatorias (3,2%), siendo en su mayoría lesiones vasculares y del diafragma (Satava grado 2) y 14 postoperatorias (4,1%). Seis pacientes presentaron complicaciones que precisaron intervención quirúrgica (Clavien IIIa/IIIb) y/o soporte en la unidad de cuidados intensivos (Clavien IV). Hubo una conversión a cirugía abierta (0,3%). A pesar de que se tomaron todas las medidas endocrinológicas preoperatorias adecuadas, un paciente portador de un feocromocitoma desarrolló en el intraoperatorio una crisis hipertensiva incontrolable y paro cardiorrespiratorio recuperado, falleciendo a los 5 días por un infarto cerebral masivo (Clavien V). Conclusiones: Las complicaciones quirúrgicas necesitan de un criterio común de estandarización mediante la aplicación combinada de 2 herramientas. Creemos que este concepto de evaluación de la morbilidad de la cirugía debe ser aplicado de forma sistemática, y de esta manera permitir a los cirujanos lograr un nuevo estándar de informes de eventos adversos perioperatorios refinado, conciso y comparativo

Objective: Laparoscopic adrenalectomy (LA) is the procedure of choice for surgical management of the adrenal masses. Our objective is to show a standardized assessment of perioperative complications in one LA series. Materials and methods: 322 LA were performed consecutively between June of 1993 and September of 2012 in patients diagnosed with suprarenal tumor. In order to evaluate perioperative complications, data were collected prospectively and analyzed retrospectively. Intraoperative complications were defined using Satava classification and Clavien-Dindo classification of postoperative complications. Results: Twenty five LA showed perioperative complications (7.3%); 11 (3.2%) were intraoperative complications, most of them vascular diaphragmatic lesions (Satava Grade 2); and 14 (4.1%) were postoperative complications. Six patients showed complications requiring surgery (Clavien IIIa/IIIb) and/or support in Intensive Care Unit (Clavien IV). Conversion to open surgery was necessary in one case (0.3%). Despite all appropriate preoperative endocrine measures were taken, an uncontrolled hypertensive crisis and cardio-respiratory arrest recovered were developed during surgery in one patient carrier of pheochromocytoma who died from massive cerebral infarction at 5 days (Clavien V). Conclusions: Standardized criteria of surgical complications are necessary. Standardization is possible by combined application of two tools. We believe that this evaluation concept of the surgery morbidity must be used systematically in order to achieve a new standard refined, concise and comparative for reports of adverse perioperative events

Complications associated with laparoscopic adrenalectomy: Description and standardized assessment.

OBJECTIVE: Laparoscopic adrenalectomy (LA) is the procedure of choice for surgical management of the adrenal masses. Our objective is to show a standardized assessment of perioperative complications in one LA series. MATERIAL AND METHODS: 322 LA were performed consecutively between June of 1993 and September of 2012 in patients diagnosed with suprarenal tumour. In order to evaluate perioperative complications, data were collected prospectively and analysed retrospectively. Intraoperative complications were defined using Satava classification and Clavien-Dindo classification of postoperative complications. RESULTS: Twenty five LA showed perioperative complications (7.3%); 11 (3.2%) were intraoperative complications, most of them vascular diaphragmatic lesions (Satava Grade 2); and 14 (4.1%) were postoperative complications. Six patients showed complications requiring surgery (Clavien IIIa/IIIb) and/or support in Intensive Care Unit (Clavien IV). Conversion to open surgery was necessary in one case (.3%). Despite all appropriate preoperative endocrine measures were taken, an uncontrolled hypertensive crisis and cardio-respiratory arrest recovered were developed during surgery in one patient carrier of pheochromocytoma who died from massive cerebral infarction at 5 days (Clavien V). CONCLUSIONS: Standardized criteria of surgical complications are necessary. Standardization is possible by combined application of two tools. We believe that this evaluation concept of the surgery morbidity must be used systematically in order to achieve a new standard refined, concise and comparative for reports of adverse perioperative events.