[Perioperative morbidity of radical prostatectomy in patients over 70 years of age]. / Morbilidad perioperatoria de la prostatectomía radical en pacientes mayores de 70 años.

INTRODUCTION: Increased life expectancy has made possible radical treatment of localized prostate cancer in patients over 70 years of age. Perioperative morbidity of radical prostatectomy in elderly patients depending on surgical procedure has not been adequately analyzed. OBJECTIVES: To comparatively analyze the incidence, severity, and management of perioperative complications of retropubic versus laparoscopic radical prostatectomy in patients older than 70 years. MATERIAL AND METHODS: A retrospective review was made of 68 patients over 70 years of age (of whom 42 underwent retropubic and 26 laparoscopic radical prostatectomy) taken from a series of 500 patients. The modified Clavien classification was used to study complications from both surgical procedures. RESULTS: The overall complication rate was 59.5% for the retropubic and 23% for the laparoscopic procedure (P=.003). Three grade I, 2 grade Id, 19 grade II, and 1 grade IId complications were seen with retropubic surgery, as compared to 2 grade I and 5 grade Id complications with the laparoscopic procedure. The most common complications included intraoperative bleeding (38%) and urinaryi fistula (15%) respectively. CONCLUSIONS: Radical prostatectomy is a procedure that is not free from complications in patients older than 70 years, though these are usually mild. The advantages usually attributed to laparoscopy also apply to elderly patients, and should therefore be considered as the procedure of choice.

Morbilidad perioperatoria de la prostatectomía radical en pacientes mayores de 70 años / Perioperative morbidity of radical prostatectomy in patients over 70 years of age

Introducción: Debido al incremento en la esperanza de vida, es posible el tratamiento radical del cáncer de próstata en pacientes mayores de 70 años. Se ha analizado poco la morbilidad perioperatoria de la prostatectomía radical en pacientes de edad avanzada en función de la técnica quirúrgica. Objetivos: Analizar la incidencia, la severidad y el manejo de las complicaciones perioperatorias de la prostatectomía radical en mayores de 70 años en función de la técnica quirúrgica, retropúbica o laparoscópica. Material y métodos: De una serie de 500 pacientes se revisa, retrospectivamente, a 68 mayores de 70 años (42 retropúbica frente a 26 laparoscópica). Empleamos la clasificación de Clavien modificada para estudiar las complicaciones de ambas técnicas quirúrgicas. Resultados: La tasa de complicaciones globales en la retropúbica fue del 59,5% y en la laparoscópica de 23% (p = 0,003). En la retropúbica se observaron 3 complicaciones de grado I, 2de grado Id, 19 de grado II y 1 de grado II d, mientras que en la laparoscópica se observaron2 de grado I y 5 de grado Id. Las complicaciones más frecuentes fueron el sangrado intraoperatorio (38%) y la fuga urinaria (15%), respectivamente. Conclusiones: La prostatectomía radical es una técnica no exenta de complicaciones, casi siempre leves, en pacientes mayores de 70 años. Las ventajas generalmente atribuidas a la laparoscopia se mantienen en los pacientes de edad avanzada, por lo que la consideramos la técnica de elección (AU)

Introduction: Increased life expectancy has made possible radical treatment of localized prostate cancer in patients over 70 years of age. Perioperative morbidity of radical prostatectomy in elderly patients depending on surgical procedure has not been adequately analyzed. Objectives: To comparatively analyze the incidence, severity, and management of perioperative complications of retropubic versus laparoscopic radical prostatectomy inpatients older than 70 years. Material and methods: A retrospective review was made of 68 patients over 70 years of age (of whom 42 underwent retropubic and 26 laparoscopic radical prostatectomy) taken from a series of 500 patients. The modified Clavien classification was used to study complications from both surgical procedures. Results: The overall complication rate was 59.5% for the retropubic and 23% for the laparoscopic procedure (P=0.003). Three grade I, 2 grade Id, 19 grade II, and 1 grade IId complications were seen with retropubic surgery, as compared to 2 grade I and 5 grade Id complications with the laparoscopic procedure. The most common complications included intraoperative bleeding (38%) and urinary fistula (15%) respectively. Conclusions: Radical prostatectomy is a procedure that is not free from complications in patients older than 70 years, though these are usually mild. The advantages usually attributed to laparoscopy also apply to elderly patients, and should therefore be considered as the procedure of choice (AU)

[The impact of statins use in clinically localized prostate cancer treated with radical prostatectomy]. / Influencia del empleo de estatinas en el cáncer de próstata clínicamente localizado tratado con prostatectomía radical.

INTRODUCTION: Use of statins has been associated with reduced risk, progression and mortality of some tumors, including prostate cancer (CaP). According to recent Studies, long-term treatment with statins significantly reduces the risk of PC and also confers a protective effect against advanced or aggressive CaP. However, there is no conclusive data regarding the potential effect on patients diagnosed with clinically localized CaP undergoing radical treatment. MATERIALS AND METHODS: A retrospective study was performed in a cohort of 250 patients that did not undergo screening and diagnosis in clinical practice of localized CaP (T1c-T2cNxM0). All patients were treated with radical prostatectomy between 2001 and 2008. Data about clinical and pathological findings, and also the existence of dyslipemia as well as treatment with statins for at least 5 years was collected and analyzed. A logistic regression analysis was performed to determine the independent predictive variables related with a more favorable pathology. RESULTS: In our study, we found a relationship, using a univariate analysis, between treatment with statins and the presence of insignificant carcinoma in the group with low or intermediate risk of recurrence. However, this relationship is not independent when we applied a multivariate analysis. DISCUSSION: Hypothesis about the potential effect of the statins preventing or inhibiting the development of high risk CaP needs to be proven applying specific clinical trials designed for this purpose. There isn't conclusive data that demonstrate that statins lower the risk of development of potentially lethal high grade CaP.

Influencia del empleo de estatinas en el cáncer de próstata clínicamente localizado tratado con prostatectomía radical / The impact of statins use in clinically localized prostate cancer treated with radical prostatectomy

Introducción: El empleo de estatinas se ha relacionado con la reducción del riesgo, progresión y mortalidad de algunos tumores, incluyendo el cáncer de próstata (CP). Según estudios recientes el tratamiento con estatinas a largo plazo no reduce significativamente el riesgo de padecer CP pero parece conferir un efecto protector frente al CP avanzado o agresivo. No existen datos concluyentes del efecto potencial en los pacientes diagnosticados de CP clínicamente localizado y sometidos a tratamiento radical. Material y métodos: Se realiza un análisis retrospectivo en una cohorte de 250 pacientes no sometidos a cribado y diagnosticados en la práctica clínica de CP localizado (T1c-T2cNxM0) tratados con prostatectomía radical desde el año 2001 a 2008. Se recogen las variables clínicas y patológicas además de la existencia de dislipemia y el tratamiento con estatinasdurante al menos 5 años. Se empleó un análisis de regresión logística para determinar las variables independientes predictoras de una patología más favorable. Resultados: En el análisis univariante hemos encontrado relación entre el tratamiento con estatinas, la presencia de carcinoma insignificante y el grupo de riesgo de recidiva bajo o intermedio. Sin embargo, está relación no es independiente en el análisis multivariante. Discusión: La hipótesis sobre el potencial efecto de las estatinas en la prevención o la inhibición del desarrollo del cáncer de alto riesgo necesita de ensayos clínicos diseñados para analizar este objetivo. Existen datos no concluyentes que parecen favorecer a los pacientes tratados con estatinas presentando un menor riesgo de CP de alto grado y probablemente letal (AU)

Introduction: Use of statins has been associated with reduced risk, progression and mortality of some tumors, including prostate cancer (CaP).According to recent Studies, long-term treatment with statins significantly reduces the risk of PC and also confers a protective effect against advanced or aggressive CaP. However, there is no conclusive data regarding the potential effect on patients diagnosed with clinically localized CaP undergoing radical treatment. Materials and methods: A retrospective study was performed in a cohort of 250 patients that did not undergo screening and diagnosis in clinical practice of localized CaP (T1c-T2cNxM0). All patients were treated with radical prostatectomy between 2001 and 2008. Data about clinical and pathological findings, and also the existence of dyslipemia as well as treatment with statins for at least 5 years was collected and analyzed. A logistic regression analysis was performed to determine the independent predictive variables related with a more favorable pathology. Results: In our study, we found a relationship, using a univariate analysis, between treatment with statins and the presence of insignificant carcinoma in the group with low or intermediate risk of recurrence. However, this relationship is not independent when we applied a multivariate analysis. Discussion: Hypothesis about the potential effect of the statins preventing or inhibiting the development of high risk CaP needs to be proven applying specific clinical trials designed for this purpose. There isn’t conclusive data that demonstrate that statins lower the risk of development of potentially lethal high grade CaP (AU)