ABSTRACT
Objective: To compare the perioperative results of adult and elderly patients undergoing laparoscopic renal surgery. Methodology: Retrospective, analytical study. 448 who underwent kidney surgery for benign or malignant pathologies between 2011-2019 were included in the General Hospital of Mexico Dr. Eduardo Liceaga. They were categorized into two groups: Group 1 <60 years and Group 2 >60 years. Descriptive statistics and bivariate analysis were performed, the calculations were performed with 95% reliability and a value of p (<0.05). Results: In the group over 60 years of age, the following was found: Age: 67.1 years (60-83). IMC 28.3 kg/m2 (19-48.7). Intra and postsurgical outcomes: intraoperative bleeding = 184.4cc (5-1700). Surgical Time = 112.6min (30-240). Days of hospital stay = 2 (1-7). Complications in 2.6% (Clavien-Dindo: I = 2; II = 1), no conversion was required in any patient. There were no statistically significant differences with group 1, an exception for intraoperative bleeding. Conclusions: Our study is a pioneer in Latin America in the evaluation of the geriatric population and outcomes with laparoscopic surgery and we recommend that renal procedures with a laparoscopic approach should be considered as the best strategy in the management of benign or malignant renal pathology in geriatric patients (AU)
Objetivo: Comparar los resultados perioperatorios depacientes adultos y adultos mayores sometidos a cirugía renal laparoscópica.Material y Métodos: Estudio retrospectivo,analítico. Se incluyeron 448 sometidos a cirugías renalespor patologías benignas o malignas entre 2011-2019 en elHospital General de México Dr. Eduardo Liceaga. Secategorizaron en dos grupos: Grupo 1 <60 años y Grupo2 >60 años. Se realizó estadística descriptiva y análisisbivariado, los cálculos se realizaron con confiabilidad del95% y un valor de p (< 0.05).Resultados: En el grupo de mayores de 60 años, seencontró lo siguiente: Edad promedio: 67.1 años (60-83).IMC 28.3 kg/m2(19-48.7). Desenlaces trans y postquirúrgicos: sangrado transoperatorio (STO) = 184.4cc (5-1700).Tiempo Quirúrgico = 112.6 min (30-240). Días de estanciaintrahospitalaria = 2 (1-7). Complicaciones en el 2.6%(Clavien-Dindo: I = 2; II = 1), no se requirió conversiónen ningún paciente. No existieron diferencias estadísticamente significativas con el grupo 1, a excepción del STO.Conclusiones: Nuestro estudio es pionero enIberoamérica en la evaluación de la población geriátricay desenlaces con cirugía laparoscópica y recomendamosque los procedimientos renales con abordaje laparoscópicodeben considerarse como la mejor estrategia en el manejode patología renal benigna o maligna en los pacientes geriátricos (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Kidney Diseases/surgery , Laparoscopy/methods , Retrospective Studies , Treatment Outcome , Operative Time , Postoperative Complications , Reproducibility of ResultsABSTRACT
OBJECTIVE: To analyse the impact on the recurrence-free biochemical survival of tumour involvement of surgical resection margins in patients with localized prostate cancer (pT2) in the prostatectomy specimen and its implications for adjuvant treatment. MATERIALS AND METHOD: Retrospective study of 536 patients with stage pT2 prostate cancer, treated with radical prostatectomy between 1996 and 2007. Subsequent to the prostatectomy, the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins and perineural invasion. We performed a univariate analysis and subsequently adjusted it by means of a Cox proportional hazard model (enter method). RESULTS: 21.7% presented positive surgical margins and 20.9% developed biochemical recurrence after a mean follow-up of 57 months. 37.9% of the patients with pathological involvement of the resection surgical margins presented biochemical recurrence against 16% that did not have it (p<0.001). In the multivariate analysis, only the surgical margin (p<0.001) and the Gleason score greater or equal to 8 (p<0.001) behaved as independent biochemical recurrence factors. On stratifying the series according to these two variables, we found that the patients with positive surgical margins and a Gleason score of ≤ 7 have a recurrence probability at 5 and 10 years of 35% and 50% against 74% and 87% in the group with positive surgical margins and a Gleason score of ≥ 8 (p=0.002). CONCLUSION: Patients with pT2 prostate cancer, positive surgical margins and a Gleason score of ≥ 8 will benefit from adjuvant radiotherapy. 50% of the patients with positive margins and a Gleason score of ≤ 7 will not recur, which means that the indication of adjuvant radiotherapy continues to be controversial.
