Day case laparoscopic nephrectomy: initial experience.

RATIONALE: Laparoscopic nephrectomy tends to become the new gold standard surgical technique in a selected population (non-functioning kidney, localised renal cell carcinoma). Day surgery is a popular pathway of care and, procedures of ever-increasing complexity are being considered. OBJECTIVE: The aim of the study was to report the postoperative complications of day case laparoscopic nephrectomy, according to the Clavien system, and, to assess the feasibility of the procedure performed as a day case. MATERIAL AND RESULTS: This study included all the patients considered for day case transperitoneal laparoscopic nephrectomy between May 2008 and November 2009. Sixteen consecutive patients were enrolled in this retrospective study. There were ten procedures on the left hand-side and six on the right hand-side. Age ranges from 22 to 77 years old. Male to female ratio was 9:7. The preoperative diagnosis was non-functioning kidney in 9 cases and kidney tumour in the other 7 cases. All but two patients have been discharged in the same day (87.5%). The readmission rate was of 12.5%. One wheel-chair bonded patient was readmitted four days after the procedure, because of adynamic ileus, and another one three days later because of wound infection. There were two grade I and one grade IV complications (Clavien system). The patient readmitted with grade IV complication, wheel-chair bonded because of cerebral palsy, was not a typical day surgery patient. DISCUSSION: The vast majority of complications were minor and resulted in no residual disability. In our small series, the day case laparoscopic nephrectomy was feasible and safe.

A comparison of sunlight exposure in men with prostate cancer and basal cell carcinoma.

Ultraviolet radiation exposure increases basal cell carcinoma (BCC) risk, but may be protective against prostate cancer. We attempted to identify exposure patterns that confer reduced prostate cancer risk without increasing that of BCC. We used a questionnaire to assess exposure in 528 prostate cancer patients and 442 men with basal cell carcinoma, using 365 benign prostatic hypertrophy patients as controls. Skin type 1 (odds ratio (OR)=0.47, 95% CI=0.26-0.86), childhood sunburning (OR=0.38, 95% CI=0.26-0.57), occasional/frequent sunbathing (OR=0.21, 95% CI=0.14-0.31), lifetime weekday (OR=0.85, 95% CI=0.80-0.91) and weekend exposure (OR=0.79, 95% CI=0.73-0.86) were associated with reduced prostate cancer risk. Skin type 1 (OR=4.00, 95% CI=2.16-7.41), childhood sunburning (OR=1.91, 95% CI=1.36-2.68), regular foreign holidays (OR=6.91, 95% CI=5.00-9.55) and weekend (OR=1.17, 95% CI=1.08-1.27) but not weekday exposure were linked with increased BCC risk. Combinations of one or two parameters were associated with a progressive decrease in the ORs for prostate cancer risk (OR=0.54-0.25) with correspondingly increased BCC risk (OR=1.60-2.54). Our data do not define exposure patterns that reduce prostate cancer risk without increasing BCC risk.

Prostate cancer risk: associations with ultraviolet radiation, tyrosinase and melanocortin-1 receptor genotypes.

Exposure to ultraviolet radiation may reduce prostate cancer risk, suggesting that polymorphism in genes that mediate host pigmentation will be associated with susceptibility to this cancer. We studied 210 prostate cancer cases and 155 controls to determine whether vitamin D receptor (VDR, Taql and Fokl variants), tyrosinase (TYR, codon 192 variant) and melanocortin-1 receptor (MC1R, Arg151Cys, Arg160Trp, Val92Met, Asp294His and Asp84Glu variants) genotypes are associated with risk. UV exposure was determined using a questionnaire. MC1R Arg(160)/Arg(160) homozygotes were at increased risk (P = 0.027, odds ratio = 1.94) while TYR A2/A2 homozygotes were at reduced risk of prostate cancer (P = 0.033, odds ratio = 0.48). These associations remained significant after correction for UV-exposure. Stratification of cases and controls by quartiles of exposure, showed that the protective effect of TYR A1A2 (P = 0.006, odds ratio 0.075) and A2A2 (P = 0.003, odds ratio 0.055) was particularly strong in subjects who had received the greatest exposure. Our data show for the first time, that allelism in genes linked with skin pigment synthesis is associated with prostate cancer risk possibly because it mediates the protective effects of UV. Importantly, susceptibility is associated with an interaction between host predisposition and exposure.

Exposure to ultraviolet radiation: association with susceptibility and age at presentation with prostate cancer.

A positive association between latitude and prostate cancer mortality has been interpreted to indicate that ultraviolet radiation (UVR) protects against development of this cancer. We aimed to examine this hypothesis. We compared exposure between 210 cases and 155 controls. Childhood sunburn (odds ratio 0.18, 95% CI 0.08-0.38), regular foreign holidays(0.41, 0.25-0.68), sunbathing score (0.83, 0.76-0.89), and low exposure to UVR (3.03, 1.59-5.78) were associated with development of prostate cancer. Furthermore, cases with low UVR exposure developed cancer at a younger median age (67.7 years, IQR 61.5-74.6) than cases with higher exposure (72.1 years, 67.5-76.4); p=0.006. These findings are compatible with UVR having a protective role against prostate cancer.

Outcome in prostate cancer associations with skin type and polymorphism in pigmentation-related genes.

Epidemiological studies have suggested that UV exerts a protective effect on prostate cancer. Accordingly, we determined, in 210 prostate cancer cases, whether parameters of exposure, skin type and polymorphism in MC1R, VDR and TYR were associated with the outcome parameters, histological grade, clinical stage and presence of bone metastases. We used logistic regression analysis, with correction for age and metastases, stage and grade in the models, to determine if the frequencies of individual factors were different in the patient groups. The development of metastases was not associated with UV exposure parameters. Paradoxically, patients with skin type 1 were at significantly reduced risk [P = 0.027, odds ratio (OR) 0.17, 95% CI 0.03-0.82] of developing metastases compared with cases with skin type 4. MC1R Val92/Val92 and VDR ff were associated with increased risk of metastases (ORs 4.30 and 4.98, respectively). Further, cumulative exposure (P = 0.005, OR 0.85/year) and increasing proportion of outdoor occupation (P = 0.001, OR 0.84/unit) were associated with reduced risk of advanced stage tumours. Skin types, MC1R or VDR genotypes were not significantly associated with advanced stage. None of the exposure parameters, skin types or genotypes were associated with tumour grade. While MC1R Val92/Val92 and VDR ff were only associated with bone metastases, TYR genotypes were associated with each of the outcome parameters. Thus, in logistic regression models that included age, but not advanced stage and high grade histology, TYR A1A2 was significantly associated with reduced risk of metastases (P = 0.033, OR 0.41). Similarly, in models that included age but not the other outcome parameters, associations between TYR A2A2 and high-grade and advanced stage were significant (P = 0.040, OR 0.41) or approached significance (P = 0.052, OR 0.44), respectively. These data indicate for the first time that pigmentation response to UV is associated with outcome in prostate cancer.