Nefrectomía parcial laparoscópica previa embolización supraselectiva como tratamiento de angiomiolipomas renales gigantes / Laparoscopic partial nephrectomy with prior superselective embolisation as treatment for giant renal angiomyolipoma

Objetivo: Los casos de angiomiolipoma renal gigante (> 9 cm) son un reto terapéutico por su baja frecuencia y su tamaño. El objetivo del tratamiento de los pacientes con angiomiolipoma renal debe ser la extirpación completa del tumor, con una técnica quirúrgica conservadora de nefronas, sin complicaciones y mediante un abordaje mínimamente invasivo. Material y métodos: Presentamos 3 casos de angiomiolipoma gigante (14, 12 y 10 cm) tratados mediante abordaje combinado: embolización supraselectiva y posterior nefrectomía parcial laparoscópica, en 3 hospitales diferentes. Resultados: Ningún caso precisó reconversión a cirugía abierta, en uno de los 3 pacientes se realizó clampaje arterial y ninguno experimentó complicaciones. Conclusiones: El abordaje combinado permite una cirugía con criterios de mínima invasión, conservadora de nefronas, con escaso sangrado y disminución del tiempo de isquemia caliente

Objective: Cases of giant renal angiomyolipoma (> 9 cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. Material and methods: We present 3 cases of giant angiomyolipoma (10 12 and 14 cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. Results: None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. Conclusions: The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time

Laparoscopic partial nephrectomy with prior superselective embolisation as treatment for giant renal angiomyolipoma. / Nefrectomía parcial laparoscópica previa embolización supraselectiva como tratamiento de angiomiolipomas renales gigantes.

OBJECTIVE: Cases of giant renal angiomyolipoma (>9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. MATERIAL AND METHODS: We present 3 cases of giant angiomyolipoma (10 12 and 14cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. RESULTS: None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. CONCLUSIONS: The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time.

[Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases]. / Respuesta a la quimioterapia adyuvante post-cistectomía en pacientes con tumor de vejiga infiltrante:análisis de 397 casos.

OBJECTIVES: To define the usefulness of adjuvant chemo-therapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease. METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given. RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy significantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) patients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-specific survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality. CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to improve cancer-specific survival, adjuvant chemotherapy may be considered as a "protective factor" (RR=0.651, p=0.08).

Respuesta a la quimioterapia adyuvante post-cistectomía en pacientes con tumor de vejiga infiltrante: Análisis de 397 casos / Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases

OBJETIVO: Conocer la utilidad de la quimioterapia adyuvante en los pacientes con enfermedad pT2, pN0, pT3-4, pN0 y pN+.MÉTODOS: Análisis retrospectivo de 397 pacientes con cáncer transicional de vejiga tratados mediante cistectomía radical entre el año 1986 y 2005. Al 40,2% de los pacientes se les administró quimioterapia adyuvante. Se administraron 3 ciclos de MVAC adyuvante (metotrexate, vinblastina, adriamicina y cisplatino).RESULTADOS: En pacientes con estadio pT3, pN0 (p=0,04) y/o N+ (p=0,001), la quimioterapia adyuvante aumentó la supervivencia cáncer-específica de forma significativa, no siendo así en pacientes pT2N0 (p=0,9) y pT4, pN0 (p=0,6). En el análisis univariante la quimioterapia adyuvante se asoció de forma significativa con una menor supervivencia cáncer-específica (RR 1,452 IC 95%: 1,028- 2,057 p= 0,03) En el análisis multivariante presentó una tendencia (RR: 0,651 IC 95% 0,398-1,065, p=0,08) a la disminución de la mortalidad cáncer-específica.CONCLUSIONES: La quimioterapia adyuvante no demostró mejorar la supervivencia en pacientes con estadio pT0-2, pN0 y pT4, pN0. En cambio, la aumentó en los pacientes con enfermedad extravesical, estadio pT3, pN0 y/o pN+. Debido a la tendencia de la quimioterapia adyuvante a mejorar la supervivencia cáncer específica podemos considerarla como “protectora” (RR=0,651, p=0,08)(AU)

OBJECTIVES: To define the usefulness of adjuvant chemotherapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease.METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given. RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy signifi-cantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) pa-tients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-speci-fic survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality.CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to im-prove cancer-specific survival, adjuvant chemotherapy may be considered as a “protective factor” (RR=0.651, p=0.08)(AU)

[Volume determinations of the whole prostate and of the adenoma by transrectal ultrasound: correlation with surgical specimen]. / Correlación ecográfico-anatómica de la medición del volumen prostático total y de la zona transicional mediante ecografía transrectal.

OBJECTIVE: We evaluated whether preoperative transrecta ultrasound (TRUS) mesaurements of the transition zone (TZ) and total prostate volumen predict real prostatic weight. MATERIAL AND METHODS: We compare estimated TRUS volumes with surgical specimen weight, in surgically treated patients with localized prostate cancer (group A, n = 33) or benign prostatic hyperplasia (group B, n = 37). The volume was calculated by the ellipsoid formula. Both measurements were compared with surgical specimen weight, assuming 1 as specific prostate weight. RESULTS: Group A: mean prostate measured volume was 38.6 cc. (SD 22.7), mean RP specimen weight was 54,2 g (SD 27.2) (p = 0.001). Total estimated prostate volume underestimated prostatectomy specimen weight by 29%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated prostate weight = 0.95 x prostatic measured volume + 17,657 (p = 0.005). Group B: mean TZ measured volume was 62.8 cc. (SD 23.3), mean adenomectomy specimen weight was 79.9 g (SD 45.9) (p = 0.001). TZ estimated volume underestimated adenomectomy specimen weight by 21%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated TZ weight = 1.67 x TZ measured volume - 24,768 (p = 0.04). CONCLUSIONS: We found significative differences between TRUS measured volumes and real weight of surgical specimen. These differences could be corrected by simple formulas that allow to minimize the observed underestimations.

Correlación ecográfico-anatómica de la medición del volumen prostático total y de la zona transicional mediante ecografía transrectal / Volume determinations of the whole prostate and of the adenoma by transrectal ultrasound: correlation with surgical specimen

Objetivo: Determinar la fiabilidad de la ecografía transrectal (ECOTR) en la medición del volumen prostático total y de la zona transicional (ZT) y buscar coeficientes de correlación capaces de mejorar la equiparación entre ambas medidas y el peso real prostático. Material y Métodos: Comparamos los volúmenes estimados mediante ECOTR con el peso de la pieza quirúrgica en pacientes con cáncer prostático localizado (grupo A, n=33) o HBP (grupo B, n= 37) sometidos a cirugía. El volumen se calculó mediante la fórmula del elipsoide. Ambas medidas se comparan con el peso de la pieza quirúrgica, asumiendo el peso específico próstatico igual a 1. Resultados: Grupo A: volumen prostático medio medido fue 38,6 cc. (DE 22,7), peso medio de la pieza de PR fue 54,2 g (DE 27,2) (p=0,001). El volumen prostático total estimado infravaloró el peso de la pieza de prostatectomía un 29%. Calculamos la fórmula para adecuar el volumen medido al peso real: peso estimado=0,95 x volumen medido prostático + 17,657 (p=0,005). Grupo B: volumen medio de ZT medido fue 62,8 cc (DE 23,3), peso medio de la pieza de adenomectomía fue 79,9 g (DE 45,9) (p=0,001). El volumen estimado del adenoma infravalora el peso de la pieza de adenomectomía un 21%. Calculamos la fórmula para adecuar el volumen medido al peso del adenoma: peso estimado=1,67 x volumen medido ZT - 24,768 (p=0,04). Conclusión: Encontramos diferencias significativas entre los volúmenes medidos por ECOTR y el peso real de la pieza quirúrgica. Estas diferencias pueden ser corregidas utilizando unas sencillas fórmulas, que permiten minimizar las infraestimaciones observadas

Objective: We evaluated whether preoperative transrecta ultrasound (TRUS) mesaurements of the transition zone (TZ) and total prostate volumen predict real prostatic weight. Material y Methods: We compare estimated TRUS volumes with surgical specimen weight, in surgically treated patients with localized prostate cancer (group A, n=33) or benign prostatic hyperplasia (group B, n=37). The volume was calculated by the ellipsoid formula. Both measurements were compared with surgical specimen weight, assuming 1 as specific prostate weight. Results: Group A: mean prostate measured volume was 38,6 cc. (SD 22,7), mean RP specimen weight was 54,2 g (SD 27,2) (p=0,001). Total estimated prostate volume underestimated prostatectomy specimen weight by 29%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated prostate weight=0,95 x prostatic measured volume + 17,657 (p=0,005). Group B: mean TZ measured volume was 62,8 cc. (SD 23,3), mean adenomectomy specimen weight was 79,9 g (SD 45,9) (p=0,001). TZ estimated volume underestimated adenomectomy specimen weight by 21%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated TZ weight=1,67 x TZ measured volume - 24,768 (p=0,04). Conclusions: We found significative differences between TRUS measured volumes and real weight of surgical specimen. These differences could be corrected by simple formulas that allow to minimize the observed underestimations