Respuesta y supervivencia libre de progresión en tumores vesicales en estadios T2-T4 tratados con tratamiento trimodal de conservación vesical / Response and Progression-Free Survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation

Objetivo: Evaluar la respuesta y la supervivencia libre de progresión (SLP) en pacientes diagnosticados de carcinoma vesical infiltrante tratados con RTU-quimioterapia-radioterapia y compararlos con una serie no aleatorizada de pacientes tratados con cistectomía radical. Material y métodos: Análisis retrospectivo de 43 pacientes con carcinoma vesical infiltrante tratados entre 1994–2007 con dos pautas de conservación vesical y estudio comparativo con pacientes sometidos a cistectomía radical (145 casos) en el mismo periodo. Las variables pronósticas para estudio fueron estadio y grado clínico, presencia o no de hidronefrosis, tratamiento quimioterapéutico recibido, dosis de radioterapia y alteraciones en p53 y Ki67. Resultados: La media y la mediana de los pacientes sometidos a conservación vesical fueron de 51 y de 39 meses, respectivamente. El 72% de los pacientes con conservación vesical obtuvo respuesta completa (RC) al finalizar el tratamiento. Solo la hidronefrosis tuvo influencia pronóstica (OR: 7,3; p=0,02). Al final del estudio, el 74% de los que obtuvieron RC mantenía la respuesta. Ninguna de las variables analizadas fueron predictoras del mantenimiento de la respuesta. La SLP en el grupo fue del 69±7 y del 61±7% a 3 y a 5 años. La dosis de radioterapia >60Gy (OR: 6,1; p=0,001) y la ausencia de hidronefrosis (OR 7,5; p=0,02) fueron las únicas variables influyentes. La SLP del grupo con RC fue del 80±7 y del 58±10% a 3 y a 5 años. Al concluir el estudio, 23/43 (53,5%) conservaban la vejiga y estaban libres de enfermedad. Se realizaron 145 cistectomías radicales a pacientes diagnosticados de carcinoma vesical infiltrante. La media y la mediana de seguimiento de este grupo fueron de 29 y 18 meses, respectivamente. El análisis estadístico reflejó que los pacientes que se habían sometido a conservación vesical presentaban únicamente peor estadio clínico que los pacientes sometidos a cistectomía radical (p=0,17).La SLP a 3 y a 5 años de los pacientes sometidos a cistectomía radical fue del 72±5 y del 63±7%, no evidenciando diferencias estadísticamente significativas (p=0,83) con respecto a los pacientes sometidos a pauta de conservación vesical. Conclusiones: Los pacientes sometidos a conservación vesical obtienen una supervivencia similar a la de los pacientes a los que se les ha realizado cistectomía radical. La dosis de radioterapia >60Gy y la ausencia de hidronefrosis son factores de influencia independiente en la SLP (AU)

Objective: To evaluate the response and the free-survival progression in pacients diagnosed of invasive bladder cancer who have been treated with transurethral resection, chemotherapy and radiotherapy. This multimodal treatment is compared with a not random serie of patients treated by radical cistectomy. Material and methods: Retrospective analysis of 43 cases of invasive bladder cancer treated with two schemes of bladder preservation between 1994–2007. They are compared with 145 cases treated with radical cistectomy in the same period of time. Pronostic variables included in the study are clinical stage, grade of differentiation, presence of ureteral obstruction, chemotherapy modality, radiotherapy doses and p53 and ki-67 expression. Results: Mean and median time are 51 and 39 months in patients with multimodal treatment. Complete response is achieved in 72% of cases treated with bladder preservation. Ureteral obstruction is a prognostic factor (OR: 7,3;p:0,02). 72% patients with complete response mantain it at the end of the study. None of analyzed variables are predictors of maintenance of the response. Survival rates with a intact bladder were 69±7% and 61±7% at three and five years. Radiotherapy doses greater than 60Gy (OR: 6,1; p<0,001) and the absence of ureteral obstruction (OR: 7,5; p<0,002) were pronostic variables. Free-survival in patients with complete response was 80±7% and 58±10% at three and five years. At the end of the study, 53,5% of patients had a intact bladder and free-disease. In the same period of time, 145 radical cistectomies were performed due to muscle invasive bladder cancer. Mean and median time in this group were 29 and 18 months respectively. Stadistical analysis reveals a worse clinical stage in the group of patients treated with multimodal treatment (p:0.01). Free-survival was 72±5% and 63±7% at 3 and 5 years in the group of radical cistectomies. There was not stadistical significant differences between cistectomies and bladder preservation. Conclusions: Patients treated with bladder preservation have a free-survival similar to those treted with radical cistectomy. Radiotherapy doses greater than 60Gy and absence of ureteral obstruction were free-survival prognostic variables (AU)

Nefrectomía parcial laparoscópica. Análisis de los primeros 30 casos de nuestra serie y revisión de la literatura / Laparoscopic Partial Nephrectomy. Analysis of first 30 cases of our series and review of the literature

Objectivo: Nuestro objetivo es analizar los resultados quirúrgicos y clínicopatológicos de nuestra serie de 30 Nefrectomías Parciales Laparoscópicas (NPL) realizadas de forma consecutiva y correlacionar los resultados con la literatura. Material y métodos: Se trata de una serie de casos, con 30 pacientes (20 varones y 10 mujeres) operados entre 2006 y 2008. Hemos valorado los factores clínico-patológicos y las complicaciones. La media y mediana de seguimiento fue de 25 y 5 meses. Resultados: Los tumores resecados tenían un tamaño medio de 2,4 cm. El 60% de los tumores fueron malignos. El estadio patológico fue pT1 en el 100% de los casos (47% grado I, 53% grado II de Furhman).Obtuvimos márgenes quirúrgicos positivos en 3 casos, reconvirtiéndolos a cirugía abierta. El sangrado intraoperatorio fue de 74,66 cc (±35,7 DE) y 70 cc de media y mediana. La media de tiempo quirúrgico fue de 214,4min (±69 DE) y tiempo de isquemia de 31,3min (±13,8 DE). Conclusiones: Nuestros resultados son superponibles a los reflejados en la literatura, exceptuando los márgenes positivos y reconversiones, atribuibles a la curva de aprendizaje (AU)

Objective: Our goal is to analyze the surgical and clinicopathological results of our first 30 laparoscopic partial nephrectomies (LPN) performed consecutively and correlate the results with the literature. Material and methods: This is a cases series, with 30 patients (20 men and 10 women) operated between 2006 and 2008. We assessed the clinicopathological factors and complications. The mean and median follow-up was 25 and 5 months. Results: Resected tumors had an average size of 2.4 cm. 60% of the tumors were malignant. The pathological stage was pT1 in 100% of cases (47% grade I, 53% Fuhrman grade II).Surgical margins were positive in 3 cases, switching to open surgery. Intraoperative bleeding was 74.66 cc (35.7±SD) and 70 cc of mean and median. The mean operative time was 214.4min (±69) and ischemia time of 31.3min (±13.8). Conclusions: Our results are similar to those reported in the literature, except for positive margins and conversion attributable to the learning curve (AU)

[Response and progression-free survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation]. / Respuesta y supervivencia libre de progresión en tumores vesicales en estadios T2-T4 tratados con tratamiento trimodal de conservación vesical.

OBJECTIVE: To evaluate the response and the free-survival progression in patients diagnosed of invasive bladder cancer who have been treated with transurethral resection, chemotherapy and radiotherapy. This multimodal treatment is compared with a not random serie of patients treated by radical cistectomy. MATERIAL AND METHODS: Retrospective analysis of 43 cases of invasive bladder cancer treated with two schemes of bladder preservation between 1994-2007. They are compared with 145 cases treated with radical cistectomy in the same period of time. Pronostic variables included in the study are clinical stage, grade of differentiation, presence of ureteral obstruction, chemotherapy modality, radiotherapy doses and p53 and ki-67 expression. RESULTS: Mean and median time are 51 and 39 months in patients with multimodal treatment. Complete response is achieved in 72% of cases treated with bladder preservation. Ureteral obstruction is a prognostic factor (OR: 7,3;p:0,02). 72% patients with complete response mantain it at the end of the study. None of analyzed variables are predictors of maintenance of the response. Survival rates with a intact bladder were 69±7% and 61±7% at three and five years. Radiotherapy doses greater than 60Gy (OR: 6,1; p<0,001) and the absence of ureteral obstruction (OR: 7,5; p<0,002) were pronostic variables. Free-survival in patients with complete response was 80±7% and 58±10% at three and five years. At the end of the study, 53,5% of patients had a intact bladder and free-disease.In the same period of time, 145 radical cistectomies were performed due to muscle invasive bladder cancer. Mean and median time in this group were 29 and 18 months respectively. Stadistical analysis reveals a worse clinical stage in the group of patients treated with multimodal treatment (p:0.01). Free-survival was 72±5% and 63±7% at 3 and 5 years in the group of radical cistectomies. There was not statistical significant differences between cistectomies and bladder preservation. CONCLUSIONS: Patients treated with bladder preservation have a free-survival similar to those treated with radical cistectomy. Radiotherapy doses greater than 60Gy and absence of ureteral obstruction were free-survival prognostic variables.

[Laparoscopic partial nephrectomy. Analysis of first 30 cases of our series and review of the literature]. / Nefrectomía parcial laparoscópica. Análisis de los primeros 30 casos de nuestra serie y revisión de la literatura.

OBJECTIVE: Our goal is to analyze the surgical and clinicopathological results of our first 30 laparoscopic partial nephrectomies (LPN) performed consecutively and correlate the results with the literature. MATERIAL AND METHODS: This is a cases series, with 30 patients (20 men and 10 women) operated between 2006 and 2008. We assessed the clinicopathological factors and complications. The mean and median follow-up was 25 and 5 months. RESULTS: Resected tumors had an average size of 2.4 cm. 60% of the tumors were malignant. The pathological stage was pT1 in 100% of cases (47% grade I, 53% Fuhrman grade II).Surgical margins were positive in 3 cases, switching to open surgery. Intraoperative bleeding was 74.66 cc (35.7±SD) and 70 cc of mean and median. The mean operative time was 214.4min (±69) and ischemia time of 31.3min (±13.8). CONCLUSIONS: Our results are similar to those reported in the literature, except for positive margins and conversion attributable to the learning curve.

[Laparoscopic adrenalectomy for metachronous metastasis. Experience in 12 cases]. / Adrenalectomía laparoscópica por metástasis metácrona. Experiencia en 12 casos.

OBJECTIVE: To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. MATERIAL AND METHODS: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. RESULTS: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5 cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. CONCLUSIONS: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery.

[Surgical complications in kidney transplantation and their influence on graft survival]. / Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto.

OBJECTIVES: To analyze surgical complications in kidney transplantation and their influence on graft survival. MATERIALS AND METHODS: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graft survival. RESULTS: At least one surgical complication occurred in 82 (38%) of the 216 transplantations, and 68 (31%) required some type of repeat surgery, 23 in the early postoperative period and 45 more than 3 months after surgery. Mean follow-up was 48 months (SD +/-33.4), and median follow-up 48 months (range, 0-166 months). No recipient or donor factors predisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3- and 5-year survival rates of 86% (95% CI 83-89) and 78% (95% CI 73-82) as compared to 92% (95% CI 90-94) and 88% (95% CI 85-91), p=0.004]. Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole group showed early repeat surgery to be a factor with an independent prognostic value (OR: 4.7; 95% CI 2.2-10, p<0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. CONCLUSION Surgical complications have an influence on graft survival. The need for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival.

Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto / Surgical complications in kidney transplantation and their influence on graft survival

Objetivo: Nuestro objetivo es analizar las complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto. Material y métodos: Analizamos retrospectivamente 216 trasplantes renales realizados entre el 1 de enero de 2000 y el 31 de diciembre de 2008, analizando las complicaciones quirúrgicas y valorando su influencia sobre la supervivencia del injerto renal. Resultados: De los 216 trasplantes, 82 (38%) tuvieron algún tipo de complicación quirúrgica y 68 (31%) requirieron algún tipo de reintervención (23 en postoperatorio inmediato y 45 más allá de los 3 meses). Media de seguimiento de 48 meses (+/−33,4 desviación estándar) y mediana de seguimiento de 48 meses (rango de 0 a 166).No se han objetivado en receptor o donante factores que predispongan a la incidencia de complicaciones. La supervivencia del injerto es significativamente menor en los pacientes con complicaciones quirúrgicas (supervivencia a los 3 y a los 5 años del 86% [intervalo de confianza {IC} 95%: 83–89] y del 78%% [IC 95%: 73–82] vs. el 92% [IC 95%: 90–94] y el 88%% [IC 95%: 85–91]; p=0,004). La reintervención precoz, la trombosis venosa y la infección de herida son las complicaciones que tienen influencia independiente en la supervivencia. El estudio multivariado de la supervivencia del injerto de todo el grupo pone de manifiesto que la reintervención precoz es un factor de influencia independiente (odds ratio: 4,7; IC 95%: 2,2–10; p<0,0001). La función diferida y la edad del donante mayor de 60 años son los otros factores influyentes. Conclusiones: Las complicaciones quirúrgicas influyen en la supervivencia del injerto. La necesidad de cirugía precoz es una variable con valor pronóstico independiente sobre supervivencia del injerto junto con la función diferida y la edad del donante (AU)

Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival. Materials and methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graft survival. Results: At least one surgical complication occurred in 82 (38%) of the 216 transplantations, and 68 (31%) required some type of repeat surgery, 23 in the early postoperative period and 45 more than 3 months after surgery. Mean follow–up was 48 months (SD +/−33.4), and median follow–up 48 months (range, 0–166 months).No recipient or donor factors predisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3- and 5-year survival rates of 86% (95% CI 83-89 %) and 78% (95% CI 73-82%) as compared to 92% (95% CI 90-94%) and 88% (95% CI 85-91%), p:0.004]. Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole group showed early repeat surgery to be a factor with an independent prognostic value (OR: 4.7; 95% CI 2.2–10, p<0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. Conclusion: Surgical complications have an influence on graft survival. The need for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival (AU)

Adrenalectomía laparoscópica por metástasis metácrona. Experiencia en 12 casos / Laparoscopic adrenalectomy for metachronous metastasis. Experience in 12 cases

Objetivos: evaluar los resultados perioperatorios y oncológicos de la adrenalectomía laparoscópica por metástasis aislada. Material y métodos: estudio retrospectivo y descriptivo de 12 adrenalectomías laparoscópicas por metástasis de un total de 40 realizadas entre mayo de 1998 y abril de 2009. El tumor primario fue en siete casos de pulmón, en tres renal y en dos de colon. Los datos demográficos de la serie incluyeron edad, tiempo operatorio, sangrado, complicaciones, tamaño tumoral y estancia hospitalaria expresados como mediana. El análisis de supervivencia se hizo con el método de Kaplan-Meier. Resultados: el tiempo operatorio fue de 150 minutos (rango 90 a 206). El sangrado intraoperatorio fue de 60 cc (rango 15 a 150). Hubo complicaciones intraoperatorias en el 3% de los casos. El tamaño tumoral fue de 4,5 cm (rango 1,3 a 8,5). No se observaron márgenes positivos en las piezas de resección. La estancia hospitalaria fue de tres días (rango 3 a 5). La supervivencia actuarial fue del 55,6% a los 23 meses (rango 2 a 38), con una media y mediana de seguimiento de 20,9 y 23 meses, respectivamente. Conclusiones: la adrenalectomía laparoscópica por metástasis en pacientes seleccionados e suna técnica segura con resultados oncológicos superponibles a los de la cirugía abierta (AU)

Objective: To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. Material and methods: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. Results: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. Conclusions: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery (AU)