Objective
To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type ...of components of ERAS play a key role on the decrease of surgical morbidity.
Materials and methods
We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate.
Results
Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (
p
< 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%,
p
= 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively,
p
= 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted RR = 0.815; 95% confidence interval (CI) 0.667–0.996;
p
= 0.045. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications.
Conclusions
Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS
Abstract Introduction Bellini's renal cell collecting duct carcinoma is a rarely prevalent renal tumor, with low cancer-specific survival, although its rate of response to antiangiogenic therapies is ...unknown. Objectives We retrospectively revise a series of collecting duct tumors, with special emphasis on the indication of target therapies and on their results. Materials and methods Retrospective analysis of renal cell collecting duct carcinoma treated at our institution from January 2000 to June 2010, taking into account the patient's age, sex, reason for the consultation, oncological background, side of the affection, surgical treatment, other anatomopathological characteristics, tumor size, TNM clinical staging (2009), adjuvant treatment and survival time. Results Six patients are described, five men and one woman, with a mean age of 75 (±7.7) years. Four of them (66.6%) presented disseminated disease upon diagnosis. Five (83%) were treated with radical nephrectomy and three (50%) received systemic adjuvant treatment, without response. The means survival was 5.5 months (4.75–14.75). Only 2 patients (33.3%), both with localized disease upon diagnosis, are in complete remission. Conclusion Renal cell collecting duct carcinoma is a disease with a bad prognosis, little survival and bad response to target therapies.
To review the unusual localizations of metastasic prostate cancer with the contribution of a clinical case of prostatic adenocarcinoma metastasis in the thyroid cartilage.
49-year-old-male admitted ...with history of 48 hour hematuria associated with lumbar pain radiating to the lower extremities and cervical tumour for 3 months.
CT scan of the thorax, abdomen and pelvis was performed showing an insufflating lesion on the left thyroid cartilage lamina suggesting chondrosarcoma, a 4 cm tumour on the posterior side of the bladder, and metastases on L4-S1 vertebral bodies and left iliac bone. Cystoscopy revealed an image on the posterior vesical wall suggesting prostatic infiltration by a tumoral process without evidence of urothelial tumors. PSA was 617 ng/ml. Digital rectal examination: Prostate with augmented consistency. Due to these results an ultrasound-guided transrectal prostatic biopsy was performed with the pathological result of Gleason 8 prostatic adenocarcinoma involving boths lobes. Complete androgen blockade with Bicalutamide and Goserelin was started with good response lowering the PSA level down to 29 ng/ml. Regarding the cervical mass suggestive of thyroid chondrosarcoma a left vertical partial laryngectomy was performed with replacement of the thyroid cartilage by septal cartilage. Pathological study of the piece revealed the presence of prostatic adenocarcinoma.
Metastatic prostate cancer in the thyroid cartilage is exceptional, there being only five cases described in the literature. This fact, linked to the scant frequency of tumours lying in this cartilage and diagnosis by means of radiological suspicion, makes it very difficult to include metastatic prostate cancer in the routine differential diagnosis of cervical masses.
Cases of giant renal angiomyolipoma (>9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete ...tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach.
We present 3 cases of giant angiomyolipoma (10 12 and 14cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals.
None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications.
The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time.
Resumen Introducción El carcinoma renal de los conductos colectores de Bellini es un tumor renal escasamente prevalente, con baja supervivencia cáncer-específica, aunque realmente se desconoce su ...tasa de respuesta a terapias antiangiogénicas. Objetivos Se revisa de manera retrospectiva una serie de tumores de túbulo colector con especial énfasis en la indicación de terapias diana y en los resultados de la misma. Material y métodos Análisis retrospectivo del carcinoma renal de túbulo colector tratados en nuestra institución desde enero 2000 a junio 2010, teniendo en cuenta la edad del paciente, el sexo, el motivo de consulta, los antecedentes oncológicos, el lado de afectación, el tratamiento quirúrgico, otras características anatomopatológicas, el tamaño tumoral, la estadificación TNM (2009), el tratamiento adyuvante y el tiempo de supervivencia. Resultados Se describen 6 pacientes, 5 varones y una mujer; con una media de edad de 75 (± 7,7) años. Cuatro de ellos (66,6%) presentaban enfermedad diseminada al diagnóstico. Cinco (83,3%) fueron tratados mediante nefrectomía radical y tres (50%) recibieron tratamiento sistémico adyuvante, sin respuesta. La mediana de supervivencia fue 5,5 meses (4,75-14,75). Sólo dos pacientes (33,3%), ambos con enfermedad localizada al diagnóstico, se encuentran en remisión completa. Conclusión El carcinoma renal de túbulo colector es una enfermedad con mal pronóstico, escasa supervivencia y mala respuesta a terapias diana.
Traumatic rupture of horseshoe kidney Molina Escudero, R; Cancho Gil, M J; Husillos Alonso, A ...
Urologia internationalis,
2012, Letnik:
88, Številka:
1
Journal Article
Recenzirano
We present the case of a 25-year-old male who came to the emergency room for pain and abdominal distension following trauma to the mesogastrium. A CT scan was performed, revealing a voluminous ...retroperitoneal hematoma with laceration of both inferior renal poles with regard to rupture of the isthmus of a horseshoe kidney. The patient presented anemization and increased pain, requiring selective embolization by means of arteriography of a branch of the right renal artery and placement of a double J stent due to urinary extravasation in the lower left kidney pole. Following 1 year of monitoring, the patient has maintained normal renal function. Renal affection in blunt abdominal trauma is frequent, occurring in 7% of previously pathological kidneys. The traumatic rupture of horseshoe kidney is facilitated by its particular anatomical characteristics, constituting an infrequent entity, knowledge of which is necessary to achieve conservative management that renders it possible to preserve renal function.
BACKGROUNDThe effect of primary androgen deprivation therapy (ADT) in patients with localized prostate cancer (PCa) has not been well documented. The objective of the present study was to analyze the ...outcome of tumors treated with ADT as primary therapy in the Spanish Prostate Cancer Registry (19.4% of the series). PATIENTS AND METHODSPatients were classified in three groups: 1) with low/intermediate risk clinically localized tumors; 2) with high risk and locally advanced (T3-4) tumors; 3) with metastatic tumors. Time to castration resistance and overall cancer-specific survival were analyzed. In non-metastatic tumors, survivals in patients treated with ADT were compared with data from patients who underwent local treatments from the Spanish Prostate Cancer Registry. RESULTS703 cases were analyzed. There were significant differences in the time to castration resistance, which was lower in the group of metastatic tumors. During follow-up, there were 179 deaths (25.5%) of which 89 (12.6%) were due to PCa. After 3 years of ADT, only 14.6% of patients in group 1 had died (1% due to PCa), 20.5% in group 2 and 46.8% in group 3 (9.2% and 31.3% due to PCa, respectively). Cancer-specific survival was significantly worse in group 1 using ADT than radical prostatectomy or radiotherapy. In high-risk and locally advanced tumors, ADT also had a lower cancer-specific survival than local treatments. CONCLUSIONA longer time until the castration resistance was observed in patients with well- and intermediate-risk localized tumors treated with ADT. Patients with metastatic tumors showed the shortest time to castration resistance.
