RESUMO
INTRODUCTION: Renal cell carcinoma (RCC) in stage T1a has partial nephrectomy (PN) as asurgical indication. The RENAL Score (RS) is useful for the prediction of post-surgical complications (PC) and recurrence. OBJECTIVE: To evaluate patients who have undergone a PN and to identify if there is an association between the RS and the achievement of the MIC. PATIENTS AND METHODS: Prospective and observational cohort that includes laparoscopic PN from March 2017 to July 2018. The RS was calculated in the pre-surgicalCT scan iv contrast. RESULTS: 33 patients were included, 69.7% were classified as low complexity RS (LRS), 27.3% medium complexity RS (MRS) and 3% high complexity RS. The meansurgical time was 146.82 min (SD 34.93), the mean warm ischemia time was 16.21 min (SD 10.29) and the estimated blood loss was 280.61 ml (SD 217.6). We found a difference in the surgical time between the means of LRS and MRS (p=0.0150), but not in the time of warm ischemia and estimated blood loss (p=0.1896 and p=0.0618). The MIC was reached in 66.6% of the sample. The mean follow-up was 10.32 months (range18-2 months), with no tumor relapse or metastasis. CONCLUSION: The laparoscopic NP in our center hasa MIC scope similar to international series, without havinga direct association with the RS.
INTRODUCCIÓN: El carcinoma de células renales (CCR) en estadio T1 tiene como indicación quirúrgica la nefrectomía parcial (NP). El RENAL Score (RS) es útil para la predicción de complicaciones post quirúrgicas (CP) y recidiva.OBJETIVO: Evaluar a los pacientes que se hayan sometido a una NP e identificar si existe asociación entre el RS y el logro del MIC (márgenes libres tumor, tiempo isquemia menor a 20 minutos, complicaciones quirúrgicas menores).PACIENTES Y MÉTODOS: Cohorte prospectiva y observacional que incluye a las NP laparoscópicas desde marzo de 2017 hasta julio de 2018. Se calculó el RS en las tomografías pre quirúrgicas con contraste endovenoso.RESULTADOS: Se incluyeron 33 pacientes, el 69,7% se clasificó como RS de baja complejidad (RSB), 27,3% RS de media complejidad (RSM) y el 3% RS de alta complejidad. El tiempo quirúrgico medio fue de 146,82 min (DE 34,93), el tiempo medio de isquemia caliente fue de 16,21 min (DE 10,29) y la pérdida hemática estimada de 280,61 ml (DE 217,6). Se halló diferencia en el tiempo quirúrgico entre las medias de RSB y RSM (p=0,0150), no así en el tiempo de isquemia caliente y pérdida hemática estimada (p=0,1896 y p=0,0618). Se alcanzó el MIC en el 66,6% de la muestra. La media de seguimiento fue de 10,32 meses (rango 18-2 meses) no observándose recaídas tumorales ni metástasis.CONCLUSIÓN: La NP laparoscópica en nuestro centro tiene un alcance del MIC similar a las series internacionales, sin tener una asociación directa con el RS.
Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia , Argentina , Humanos , Recidiva Local de Neoplasia , Nefrectomia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Although overt thyrotoxicosis is associated with reduced insulin sensitivity (IS), the effects of subclinical thyrotoxicosis (SCTox) (i.e., suppressed serum thyroid-stimulating hormone with free thyroxine and tri-iodothyronine within the reference range) on glucose metabolism are not clear. SCTox may be of endogenous origin or due to ingestion of supraphysiological amounts of thyroid hormone. Our hypotheses were that reduced IS is present in SCTox and that the degree of reduction differs between SCTox of endogenous and exogenous origin. METHODS: The study population consisted of 125 premenopausal, normal-weight women, divided into four groups: exogenous SCTox due to L-T4 treatment for benign goiter or hypothyroidism (SCTox-ExogG) (n = 53), endogenous SCTox (SCTox-Endog) (n = 12), exogenous SCTox due to L-T4 treatment for differentiated thyroid cancer (SCTox-ExogDTC) (n = 20), and finally euthyroid women (C) (n = 40) as a control group. After a mixed meal challenge, glucose and insulin were determined at baseline and 120 minutes later. IS was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) index, quantitative IS check index (QUICKI), and 2 hours IS Avignon's index amended by Aloulou for mixed food. Secretion by pancreatic B-cells was calculated by HOMA-B index. Comparison among groups was done by analysis of variance followed by Tukey test. Linear regression analysis of T3 versus HOMA-IR was calculated. RESULTS: IS was reduced in all types of SCTox when compared with C. All SCTox groups had significantly higher levels of insulin (baseline and postmeal) and HOMA-IR and lower values of QUICKI and Aloulou when compared with controls. SCTox-Endog, however, had higher baseline insulin levels and HOMA-IR and a lower QUICKI index than the rest of the SCTox groups. Although within the normal range, total T4, free T4, and T3 levels were also significantly higher in the SCTox groups than in euthyroids. In SCTox-Endog, T3/T4 ratio was increased above the rest of SCTox groups. A moderate linear relationship between T3 and HOMA-IR was found in the whole population. CONCLUSIONS: IR is associated with SCTox of either endogenous or exogenous origin. However, based on our findings of lower IS compared with the rest of the SCTox groups, the endogenous subclinical form might have an even larger metabolic impact.