RESUMO
ABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.
Assuntos
Humanos , Masculino , Feminino , Idoso , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/fisiopatologia , Medição de Risco/métodos , Rim/fisiopatologia , Neoplasias Renais/cirurgia , Neoplasias Renais/fisiopatologia , Nefrectomia/métodos , Período Pós-Operatório , Valores de Referência , Fatores de Tempo , Carcinoma de Células Renais/patologia , Modelos Logísticos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Estatísticas não Paramétricas , Creatinina/sangue , Isquemia Quente/métodos , Período Pré-Operatório , Taxa de Filtração Glomerular , Rim/cirurgia , Rim/irrigação sanguínea , Rim/patologia , Neoplasias Renais/patologia , Pessoa de Meia-Idade , Nefrectomia/efeitos adversosRESUMO
INTRODUCTION: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. MATERIALS AND METHODS: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF < 45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. RESULTS: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). CONCLUSIONS: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.
Assuntos
Carcinoma de Células Renais/fisiopatologia , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/fisiopatologia , Neoplasias Renais/cirurgia , Rim/fisiopatologia , Nefrectomia/métodos , Medição de Risco/métodos , Idoso , Carcinoma de Células Renais/patologia , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/irrigação sanguínea , Rim/patologia , Rim/cirurgia , Neoplasias Renais/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Isquemia Quente/métodosRESUMO
PURPOSE: The aim of the study was to analyse and compare the ability of multiparametric magnetic resonance imaging (mp-MRI) and prostate biopsy (PB) to correctly identify tumor foci in patients undergoing radical prostatectomy (RP) for prostate cancer (PCa). MATERIALS AND METHODS: 157 patients with clinically localised PCa with a PSA <10 ng/ mL and a negative DRE diagnosed on the first (12 samples, Group A) or second (18 samples, Group B) PB were enrolled at our institution. All patients underwent mp-MRI with T2-weighted images, diffusion-weighted imaging, dynamic contrast enhanced-MRI prior to RP. A map of comparison describing each positive biopsy sample was created for each patient, with each tumor focus shown on the MRI and each lesion present on the definitive histological examination in order to compare tumor detection and location. The sensitivity of mp-MRI and PB for diagnosis was compared using Student's t-test. The ability of the two exams to detect the prevalence of Gleason pattern 4 in the identified lesions was compared using a chi-square test. RESULTS: Overall sensitivity of PB and mp-MRI to identify tumor lesion was 59.4% and 78.9%, respectively (p<0.0001). PB missed 144/355 lesions, 59 of which (16.6%) were significant. mp-MRI missed 75/355 lesions, 12 of which (3.4%) were significant. No lesions with a GS≥8 were missed. Sensitivity of PB and mp-MRI to detect the prevalence of Gleason pattern 4 was 88.2% and 97.4%, respectively. CONCLUSIONS: mp-MRI seems to identify more tumor lesions than PB and to provide more information concerning tumor characteristics.
Assuntos
Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Idoso , Humanos , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Gradação de Tumores , Período Pré-Operatório , Próstata/patologia , Antígeno Prostático Específico/sangue , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Carga TumoralRESUMO
Purpose The aim of the study was to analyse and compare the ability of multiparametric magnetic resonance imaging (mp–MRI) and prostate biopsy (PB) to correctly identify tumor foci in patients undergoing radical prostatectomy (RP) for prostate cancer (PCa). Materials and Methods 157 patients with clinically localised PCa with a PSA <10 ng/mL and a negative DRE diagnosed on the first (12 samples, Group A) or second (18 samples, Group B) PB were enrolled at our institution. All patients underwent mp-MRI with T2-weighted images, diffusion-weighted imaging, dynamic contrast enhanced-MRI prior to RP. A map of comparison describing each positive biopsy sample was created for each patient, with each tumor focus shown on the MRI and each lesion present on the definitive histological examination in order to compare tumor detection and location. The sensitivity of mp-MRI and PB for diagnosis was compared using Student’s t-test. The ability of the two exams to detect the prevalence of Gleason pattern 4 in the identified lesions was compared using a chi-square test. Results Overall sensitivity of PB and mp-MRI to identify tumor lesion was 59.4% and 78.9%, respectively (p<0.0001). PB missed 144/355 lesions, 59 of which (16.6%) were significant. mp-MRI missed 75/355 lesions, 12 of which (3.4%) were significant. No lesions with a GS≥8 were missed. Sensitivity of PB and mp-MRI to detect the prevalence of Gleason pattern 4 was 88.2% and 97.4%, respectively. Conclusions mp-MRI seems to identify more tumor lesions than PB and to provide more information concerning tumor characteristics. .
Assuntos
Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Ilustração Médica , Gradação de Tumores , Período Pré-Operatório , Antígeno Prostático Específico/sangue , Próstata/patologia , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Carga TumoralRESUMO
OBJECTIVE: Extended pelvic lymph nodes dissection (EPLND) allows the removal of a higher number of lymph nodes than limited PLND. The aims of this study were to describe our robot-assisted EPLND (RAEPLND) technique with related complications, and to report the number of lymph nodes removed and the rate of lymph nodal metastasis. MATERIALS AND METHODS: 153 patients underwent RAEPLND prior to robot-assisted radical prostatectomy (RARP). Indications were defined according to Briganti nomogram, to predict risk of lymph-nodal metastasis. Lymphatic packages covering the distal tract of the common iliac artery, the medial portion of the external iliac artery, the external iliac vein and the internal iliac vessels, together with the obturator and the presacral lymphatic packages were removed on both sides. RESULTS: Median preoperative PSA was 7.5 ng/mL (IQR 5.5-11.5). Median operative time was 150 min (135-170). Median RAEPLND alone operative time was 38 min (32.75-41.25); for right and left side, 18 (15-29) and 20 min (15.75-30) (p=0.567). Median number of lymph nodes retrieved per patient was 25 (19.25-30); 13 (11-16) and 11 (8-15) for right and left side. In 19 patients (12.41%) metastasis was found at the level of pelvic lymph nodes. Median number of positive lymph nodes was 1 (1-4.6) per patient. Complications occurred in 11 patients (7.3%). CONCLUSIONS: the number of lymph nodes removed was comparable to published data about open series, allowing the increase of detection rate of lymph nodal metastasis for minimally invasive approach without compromising complications' rate if performing the procedure following reported technique.
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Excisão de Linfonodo/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Humanos , Artéria Ilíaca/cirurgia , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Metástase Linfática , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Duração da Cirurgia , Pelve , Complicações Pós-Operatórias , Prognóstico , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Neoplasias da Próstata/patologia , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversosRESUMO
PURPOSE: To evaluate the results of our technique of clampless laparoscopic partial nephrectomy (LPN) and its impact as an emerging treatment for small renal masses (SMRs). MATERIALS AND METHODS: We reviewed our prospectively maintained database: data of 117 patients who consecutively underwent LPN at our Institution from January 2009 to December 2011 were studied. Patients were divided into 2 Groups based on operative technique: Group A: clampless-LPN (cl-LPN); Group B: conventional LPN (clamping of renal artery). Demographic and peri-operative data, complications, pre- and post-operative serum creatinine and estimated glomerular filtration rate (eGFR) were registered and compared by Student's t- and Chi-square-tests (p-values < 0.05 considered statistically significant). RESULTS: 41 patients were in Group A and 76 in Group B. Groups were comparable in terms of preoperative data except for tumour's size (2.35 ± 1.10 vs. 3.19 ± 1.57, Group A vs. B, respectively, p = 0.0029). Concerning perioperative data, warm ischemia time (WIT) was 0 min. in all Group A cases; mean WIT in Group B was 20.90 ± 9.27 min. One case (2.4%) in Group A (central tumour) was converted to conventional LPN. Mean eGFR postoperative decrease was higher in Group B (0.17 ± 9.30 vs. 4.38 ± 11.37 mL/min., A vs B, respectively, p = 0.0445). CONCLUSIONS: Notwithstanding the limits of the study, our results suggest that cl-LPN is a safe and effective technique, which allows surgeon to surgically treat SRMs even in case of complex location, without injuring kidney by ischemia.
Assuntos
Laparoscopia/métodos , Nefrectomia/métodos , Néfrons/cirurgia , Tratamentos com Preservação do Órgão/métodos , Idoso , Distribuição de Qui-Quadrado , Feminino , Taxa de Filtração Glomerular , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrectomia/estatística & dados numéricos , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the results of our technique of clampless laparoscopic partial nephrectomy (LPN) and its impact as an emerging treatment for small renal masses (SMRs). MATERIALS AND METHODS: We reviewed our prospectively maintained database: data of 117 patients who consecutively underwent LPN at our Institution from January 2009 to December 2011 were studied. Patients were divided into 2 Groups based on operative technique: Group A: clampless-LPN (cl-LPN); Group B: conventional LPN (clamping of renal artery). Demographic and peri-operative data, complications, pre- and post-operative serum creatinine and estimated glomerular filtration rate (eGFR) were registered and compared by Student’s t- and Chi-square-tests (p-values < 0.05 considered statistically significant). RESULTS: 41 patients were in Group A and 76 in Group B. Groups were comparable in terms of preoperative data except for tumour’s size (2.35 ± 1.10 vs. 3.19 ± 1.57, Group A vs. B, respectively, p = 0.0029). Concerning perioperative data, warm ischemia time (WIT) was 0 min. in all Group A cases; mean WIT in Group B was 20.90 ± 9.27 min. One case (2.4%) in Group A (central tumour) was converted to conventional LPN. Mean eGFR postoperative decrease was higher in Group B (0.17 ± 9.30 vs. 4.38 ± 11.37 mL/min., A vs B, respectively, p = 0.0445). CONCLUSIONS: Notwithstanding the limits of the study, our results suggest that cl-LPN is a safe and effective technique, which allows surgeon to surgically treat SRMs even in case of complex location, without injuring kidney by ischemia.