Nefrectomía parcial y radical laparoscópica en tumores renales cT1. Análisis comparativo de complicaciones y supervivencia / Laparoscopic nephron sparing surgery and radical nephrectomy in cT1 renal tumors. Comparative analysis of complications and survival

Introducción y objetivos: Análisis comparativo de complicaciones postoperatorias y supervivencia entre nefrectomía parcial (NP) y radical (NR) laparoscópica en cáncer de células renales (CCR) cT1.Material y método: Estudio retrospectivo de pacientes birrenos con tumor renal único cT1 tratados en nuestro centro entre los años 2005 y 2018 mediante NP o NR laparoscópica.Resultados: Cumplieron los criterios de inclusión para el estudio 372 pacientes. Fueron tratados mediante NR 156 (41,9%) y 216 (58,1%) mediante NP. En 10 (4,6%) NP y 6 (3,9%) NR hubo complicaciones Clavien Dindo III-V (p = 0,75). El índice de comorbilidad de Charlson (ICC) se identificó como variable predictora independiente de complicaciones (p = 0,02), no influyendo el tipo de cirugía en el análisis multivariante. La estimación de la supervivencia global (SG) fue de 81,2 y de 56,8% a los 5 y 10 años en el grupo de NR y de 90,2 y 75,7% en el grupo de NP, respectivamente (p = 0,0001). Se identificaron como factores predictores de mortalidad global la obesidad (HR 2,77, p = 0,01), el ICC ≥ 3 (HR 3,69, p = 0,001) y el FG<60 mL/min/1,73 m2 al alta (HR 1,87,p = 0,03). El tipo de nefrectomía no demostró influencia en la SG. La estimación de la supervivencia libre de recidiva (SLR) fue de 86,1% a los 5 y 10 años en el grupo de NR y de 93,5 y 83,6% en el grupo de NP respectivamente (p = 0,22).Conclusiones: La NP laparoscópica no es inferior a la NR en términos de seguridad oncológica y quirúrgica en el CCR cT1. El tipo de nefrectomía no influyó en la SG del paciente, sin embargo, sí se comportaron como factores predictores la obesidad, el índice Charlson ≥ 3 y el FG<60 mL/min/1,73 m2 al alta (AU)

Introduction and objectives: Comparative analysis of postoperative complications and survival between laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) in cT1 renal cell carcinoma (RCC).Material and method: Retrospective study of patients with two kidneys and single renal tumor cT1 treated in our center between 2005 and 2018 by laparoscopic PN or RN.Results: 372 patients met the inclusion criteria for the study. RN was performed in 156 (41.9%) patients and PN in 216 (58.1%). Clavien Dindo III-V complications were observed in 10 (4,6%) PN and 6 (3,9%) RN patients (p = 0.75). The comorbidity Charlson index (CCI) was identified as an independent predictor variable of complications (p = 0.02) and surgical approach did not affect multivariate analysis. Estimated overall survival (OS) was 81.2% and 56.8% at 5 and 10 years in the RN group and 90.2% and 75.7% in the PN group, respectively (p = 0.0001). Obesity (HR 2.77, p = 0.01), CCI ≥ 3 (HR 3.69, p = 0.001) and glomerular filtration rate (GFR) < 60 mL/min/1.73m2 at discharge (HR 1.87, p = 0.03) were identified as predictors of overall mortality. Nephrectomy approach showed no influence on OS. Estimated recurrence-free survival (RFS) was 86.1% at 5 and 10 years in the RN group and 93.5% and 83.6% in the PN group, respectively (p = 0.22).Conclusions: Laparoscopic PN is not inferior to RN in terms of oncologic and surgical safety in cT1 RCC. Nephrectomy approach did not influence patient OS, however, obesity, CCI ≥ 3 and GFR<60 mL/min/1.73m2 at discharge did behave as predictors (AU)

Laparoscopic nephron sparing surgery and radical nephrectomy in cT1 renal tumors. Comparative analysis of complications and survival.

INTRODUCTION AND OBJECTIVES: Comparative analysis of postoperative complications and survival between laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) in cT1 renal cell carcinoma (RCC). MATERIAL AND METHOD: Retrospective study of patients with two kidneys and single renal tumor cT1 treated in our center between 2005 and 2018 by laparoscopic PN or RN. RESULTS: 372 patients met the inclusion criteria for the study. RN was performed in 156 (41.9%) patients and PN in 216 (58.1%). Clavien Dindo III-V complications were observed in 10 (4,6%) PN and 6 (3,9%) RN patients (p = 0.75). The comorbidity Charlson index (CCI) was identified as an independent predictor variable of complications (p = 0.02) and surgical approach did not affect multivariate analysis. Estimated overall survival (OS) was 81.2% and 56.8% at 5 and 10 years in the RN group and 90.2% and 75.7% in the PN group, respectively (p = 0.0001). Obesity (HR 2.77, p = 0.01), CCI ≥ 3 (HR 3.69, p = 0.001) and glomerular filtration rate (GFR) <60 mL/min/1.73 m2 at discharge (HR 1.87, p = 0.03) were identified as predictors of overall mortality. Nephrectomy approach showed no influence on OS. Estimated recurrence-free survival (RFS) was 86.1% at 5 and 10 years in the RN group and 93.5% and 83.6% in the PN group, respectively (p = 0.22). CONCLUSIONS: Laparoscopic PN is not inferior to RN in terms of oncologic and surgical safety in cT1 RCC. Nephrectomy approach did not influence patient OS, however, obesity, CCI ≥ 3 and GFR <60 mL/min/1.73 m2 at discharge did behave as predictors.

Evolución de la función renal en pacientes con cáncer renal cT1 después de nefrectomía parcial y radical laparoscópica. Factores predictores de deterioro de función renal / Evolution of renal function in patients with cT1 renal tumors after laparoscopic partial and radical nephrectomy. Predictive factors for renal function impairment

Introducción y objetivos Analizar la evolución de la función renal tras nefrectomía parcial (NP) y radical (NR) laparoscópica e identificar factores predictores de deterioro de función renal.Material y método Estudio retrospectivo de pacientes birrenos con filtrado glomerular (FG) > 60 mL/min/1,73 m2 y tumor renal único cT1 tratados en nuestro centro entre los años 2005 y 2018.Resultados 372 pacientes cumplieron los criterios de inclusión para el estudio. 156 (41,9%) fueron tratados mediante NR y 216 (58,1%) mediante NP. Al alta hubo una diferencia de 26,75 mL/min/1,73 m2 de FG entre NR y NP. La edad > 60 años, las complicaciones postoperatorias (OR 2,97, p = 0,005) y NR (OR 10,03, p = 0,0001) fueron factores predictores de FG<60 mL/min/1,73 m2 al alta. Únicamente la NR (OR 7,69, p = 0,0001) se comportó como factor pronóstico independiente de FG<45 mL/min/1,73 m2 al alta. La mediana de seguimiento de la serie fue de 57 (IQR 28 - 100) meses. Al final del seguimiento, nueve (6%) pacientes tratados con NR desarrollaron enfermedad renal crónica (ERC) grave y tres (2%) insuficiencia renal terminal (IRT). Edad > 70 años, diabetes mellitus (DM) (HR 2,12, p = 0,001), hipertensión arterial (HTA) (HR 1,73, p = 0,01) y NR (HR 2,88, p = 0,0001) se comportaron como factores predictores independientes de FG<60 mL/min/1,73 m2. Para un FG<45 mL/min/1,73 m2 fueron edad > 70 años, DM (HR 1,99 IC 95% 1,04 a 3,83, p = 0,04) y NR (HR 5,88 IC 95% 2,57 a 13,45, p = 0,0001).Conclusiones La NR es un factor de riesgo a corto y largo plazo de ERC, aunque con baja probabilidad de ERC grave o IRT en pacientes con FG > 60 mL/min/1,73 m2 preoperatoria. La edad, DM e HTA contribuyen al empeoramiento de la función renal durante el seguimiento (AU)

Introduction and objectives To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for deterioration in kidney function.Material and method Retrospective study of patients with two kidneys, glomerular filtration rate (GFR) > 60 mL/min/1.73 m2, and single renal tumor cT1, treated in our center between 2005 and 2018.Results A total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated by RN and 216 (58.1%) by PN. There was a difference of 26.75 mL/min/1.73 m2 in GFR between RN and PN at discharge. Age > 60 years, postoperative complications (OR 2.97, p = 0.005) and RN (OR 10.03, p = 0.0001) were predictors of GFR<60 mL/min/1.73 m2 at discharge. Only RN (OR 7.69, p = 0.0001) behaved as an independent prognostic factor for GFR<45 mL/min/1.73m2 at discharge. The median follow-up of the series was 57 (IQR 28-100) months. At the end of the follow-up period, nine (6%) patients treated with RN developed severe chronic kidney disease (CKD) and three (2%) developed end stage renal disease (ESRD). Age > 70 years, diabetes mellitus (DM) (HR 2.12, p = 0.001), arterial hypertension (AHT) (HR 1.73, p = 0.01) and RN (HR 2.88, p = 0.0001) behaved as independent predictors of GFR<60 mL/min/1.73 m2. The independent predictors for GFR< 45 mL/min/1.73m2 were age >70 years, DM (HR 1.99 CI 95% 1.04-3.83, p = 0.04) and RN (HR 5.88 CI 95% 2.57-13.45, p = 0.0001).Conclusions RN is a short- and long-term risk factor for CKD, although with a low probability of severe CKD or ESRD in patients with preoperative GFR > 60 mL/min/1.73 m2. Age, DM and AHT contribute to worsening renal function during follow-up (AU)

Evolution of renal function in patients with cT1 renal tumors after laparoscopic partial and radical nephrectomy. Predictive factors for renal function impairment.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for renal function impairment. MATERIALS AND METHOD: Retrospective study of patients with two kidneys, glomerular filtration rate (GFR) > 60 mL/min/1.73 m2 and single renal tumor cT1, treated in our center between 2005 and 2018. RESULTS: A total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated with RN and 216 (58.1%) with PN. There was a difference of 26.75 mL/min/1.73 m2 in GFR between RN and PN at discharge. Age >60 years, postoperative complications (OR 2.97, p = 0.005) and RN (OR 10.03, p = 0.0001) were predictors of GFR <60 mL/min/1.73 m2 at discharge. Only RN (OR 7.69, p = 0.0001) behaved as an independent prognostic factor for GFR <45 mL/min/1.73 m2 at discharge. The median follow-up of the series was 57 (IQR 28-100) months. At the end of the follow-up period, nine (6%) patients treated with RN developed severe chronic kidney disease (CKD) and three (2%) developed end stage renal disease (ESRD). Age >70 years, diabetes mellitus (DM) (HR 2.12, p = 0.001), arterial hypertension (AHT) (HR 1.73, p = 0.01) and RN (HR 2.88, p = 0.0001) behaved as independent predictors of GFR <60 mL/min/1.73 m2. The independent predictors for GFR <45 mL/min/1.73 m2 were age >70 years, DM (HR 1.99 CI 95% 1.04-3.83, p = 0.04) and RN (HR 5.88 CI 95% 2.57-13.45, p = 0.0001). CONCLUSIONS: RN is a short- and long-term risk factor for CKD although with a low probability of severe CKD or ESRD in patients with preoperative GFR >60 mL/min/1.73 m2. Age, DM and AHT contribute to worsening renal function during follow-up.

Evolution of renal function in patients with CT1 renal tumors after laparoscopic partial and radical nephrectomy. Predictive factors for renal function impairment. / Evolución de la función renal en pacientes con cáncer renal cT1 después de nefrectomía parcial y radical laparoscópica. Factores predictores de deterioro de función renal.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for deterioration in kidney function. MATERIALS AND METHOD: Retrospective study of patients with two kidneys, glomerular filtration rate (GFR) > 60 mL/min/1.73 m2, and single renal tumor cT1, treated in our center between 2005 and 2018. RESULTS: A total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated by RN and 216 (58.1%) by PN. There was a difference of 26.75 mL/min/1.73 m2 in GFR between RN and PN at discharge. Age > 60 years, postoperative complications (OR 2.97, p = 0.005) and RN (OR 10.03, p = 0.0001) were predictors of GFR < 60 mL/min/1.73 m2 at discharge. Only RN (OR 7.69, p = 0.0001) behaved as an independent prognostic factor for GFR < 45 mL/min/1.73m2 at discharge. The median follow-up of the series was 57 (IQR 28-100) months. At the end of the follow-up period, nine (6%) patients treated with RN developed severe chronic kidney disease (CKD) and three (2%) developed end stage renal disease (ESRD). Age > 70 years, diabetes mellitus (DM) (HR 2.12, p = 0.001), arterial hypertension (AHT) (HR 1.73, p = 0.01) and RN (HR 2.88, p = 0.0001) behaved as independent predictors of GFR < 60 mL/min/1.73 m2. The independent predictors for GFR< 45 mL/min/1.73m2 were age >70 years, DM (HR 1.99 CI 95% 1.04-3.83, p = 0.04) and RN (HR 5.88 CI 95% 2.57-13.45, p = 0.0001). CONCLUSIONS: RN is a short- and long-term risk factor for CKD, although with a low probability of severe CKD or ESRD in patients with preoperative GFR > 60 mL/min/1.73 m2. Age, DM and AHT contribute to worsening renal function during follow-up.

Predicción de recidiva bioquímica tras prostatectomía radical. Nueva herramienta para la selección de candidatos a radioterapia adyuvante / Prediction of biochemical recurrence after radical prostatectomy. New tool for selecting candidates for adjuvant radiation therapy

Objetivo: Diseñar un sumatorio de riesgo para la selección de pacientes para radioterapia adyuvante después de prostatectomía. Material y método: Estudio retrospectivo de 629 pacientes con cáncer de próstata localizado y pN0-pNx tratados con prostatectomía y con un PSA a los 2-3 meses < 0,2 ng/ml. Recidiva bioquímica si PSA > 0,4 ng/ml. Análisis multivariante mediante regresión de Cox. Asignación de puntuación (0-2) en función del HR de las variables significativas. El sumatorio de las puntuaciones definió el sumatorio de riesgo. Resultados: El 19,7% pT3, 24,2% Gleason ≥ 8 y el 26,3% de márgenes quirúrgicos positivos. Mediana de seguimiento de 82 meses. Recidiva bioquímica el 26,6%. El Gleason = 7 (4 + 3) (HR = 2,01, p = 0,008), el Gleason ≥ 8 (HR = 3,07, p < 0,001), el estadio pT3b (HR = 1,93, p = 0,008) y el margen quirúrgico positivo (HR = 2,20, p < 0,001) se identificaron como variables pronosticas independientes de recidiva bioquímica. Se asignó 0 puntos a los pacientes sin variables pronósticas de riesgo, un punto a los pacientes con Gleason = 7 (4 + 3), pT3b o márgenes quirúrgicos positivos y 2 puntos si Gleason ≥ 8. Los pacientes con un sumatorio de riesgo ≤ 2 tuvieron una supervivencia libre de recidiva bioquímica a los 5 y 8 años superior al 50%, en cambio, los pacientes con un sumatorio de riesgo ≥ 3 tuvieron una supervivencia libre de recidiva bioquímica inferior al 44%. Conclusión: Los pacientes con un sumatorio de riesgo ≤ 2 no se beneficiarían de radioterapia adyuvante, mientras que los pacientes con un sumatorio de riesgo ≥ 3 pudieran beneficiarse de radioterapia adyuvante

Objective: To design a risk summation to select patients for adjuvant radiation therapy after prostatectomy. Materials and method: A retrospective study was conducted on 629 patients with localised prostate cancer (pN0–pNx) who were treated with prostatectomy and with a prostate-specific antigen (PSA) value < 0.2 ng/mL at 2–3 months. Biochemical recurrence was defined as a PSA > 0.4 ng/mL. A multivariate Cox regression analysis was performed. A score (0–2) was assigned according to the hazard ratio of the significant variables. The score summation defined the risk summation. Results: A total of 19.7% of the patients were pT3, 24.2% had a Gleason score ≥8, and 26.3% had positive surgical margins. The median follow-up was 82 months. Some 26.6% of the patients experienced biochemical recurrence. The identified prognostic variables independent of biochemical recurrence were a Gleason score = 7 (4 + 3) (HR, 2.01; P = .008), a Gleason score ≥ 8 (HR, 3.07; P < .001), a pT3b stage (HR, 1.93; p = .008) and a positive surgical margin (HR, 2.20; P < .001). We assigned 0 points to patients without risk prognosis variables; 1 point to patients with Gleason scores = 7 (4 + 3), pT3b or positive surgical margins; and 2 points to patients with Gleason scores ≥ 8. The patients with a risk summation ≤ 2 had > 50% survival free of biochemical recurrence at 5 and 8 years. In contrast, the patients with a risk summation ≥ 3 had <44% survival free of biochemical recurrence. Conclusion: The patients with a risk summation ≤ 2 did not benefit from adjuvant radiation therapy, while the patients with a risk summation ≥ 3 might benefit from adjuvant radiation therapy

Prediction of biochemical recurrence after radical prostatectomy. New tool for selecting candidates for adjuvant radiation therapy.

OBJECTIVE: To design a risk summation to select patients for adjuvant radiation therapy after prostatectomy. MATERIALS AND METHOD: A retrospective study was conducted on 629 patients with localised prostate cancer (pN0-pNx) who were treated with prostatectomy and with a prostate-specific antigen (PSA) value <0.2ng/mL at 2-3 months. Biochemical recurrence was defined as a PSA >0.4ng/mL. A multivariate Cox regression analysis was performed. A score (0-2) was assigned according to the hazard ratio of the significant variables. The score summation defined the risk summation. RESULTS: A total of 19.7% of the patients were pT3, 24.2% had a Gleason score ≥ 8, and 26.3% had positive surgical margins. The median follow-up was 82 months. Some 26.6% of the patients experienced biochemical recurrence. The identified prognostic variables independent of biochemical recurrence were a Gleason score =7 (4+3) (HR, 2.01; P=.008), a Gleason score ≥ 8 (HR, 3.07; P <.001), a pT3b stage (HR, 1.93; p=.008) and a positive surgical margin (HR, 2.20; P<.001). We assigned 0 points to patients without risk prognosis variables; 1 point to patients with Gleason scores =7 (4+3), pT3b or positive surgical margins; and 2 points to patients with Gleason scores ≥ 8. The patients with a risk summation ≤ 2 had >50% survival free of biochemical recurrence at 5 and 8 years. In contrast, the patients with a risk summation ≥ 3 had <44% survival free of biochemical recurrence. CONCLUSION: The patients with a risk summation ≤ 2 did not benefit from adjuvant radiation therapy, while the patients with a risk summation ≥ 3 might benefit from adjuvant radiation therapy.