A. Rincón Mayans

Surgical complications in kidney transplantation and their influence on graft survival

OBJECTIVES To analyze surgical complications in kidney transplantation and their influence on graft survival. MATERIALS AND METHODS A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graft survival. RESULTS At least one surgical complication occurred in 82 (38%) of the 216 transplantations, and 68 (31%) required some type of repeat surgery, 23 in the early postoperative period and 45 more than 3 months after surgery. Mean follow-up was 48 months (SD +/-33.4), and median follow-up 48 months (range, 0-166 months). No recipient or donor factors predisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3- and 5-year survival rates of 86% (95% CI 83-89) and 78% (95% CI 73-82) as compared to 92% (95% CI 90-94) and 88% (95% CI 85-91), p=0.004]. Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole group showed early repeat surgery to be a factor with an independent prognostic value (OR: 4.7; 95% CI 2.2-10, p<0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. CONCLUSION Surgical complications have an influence on graft survival. The need for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival.

Linfadenectomía (ampliada vs estándar) y cáncer de próstata

Resumen El papel y el beneficio potencial de la linfadenectomia en el cancer de prostata sigue siendo motivo de controversia. Generalmente se acepta que la linfadenectomia en el momento de realizarse la prostatectomia radical es el unico procedimiento diagnostico que nos acerca a un estadiaje anatomopatologico mas preciso permitiendonos un mejor manejo postoperatorio. Sin embargo la extension de la diseccion linfatica (limitada vs extensa) y los candidatos mas adecuados para estos procedimientos sigue siendo motivo de intenso debate. El proposito de este articulo de revision es una evaluacion critica del papel actual de la diseccion linfatica en el cancer de prostata.

Adenocarcinoma de próstata Gleason clínico 8-10: influencia pronóstica en la supervivencia libre de progresión bioquímica

OBJECTIVE Hereby, we analyze the characteristics of the clinical Gleason 8-10 group of patients with in our series diagnosed of Prostate Cancer and treated by means of radical prostatectomy, and we try to ascertain which are the influence factors within this group upon progression and progression free survival. MATERIAL AND METHODS From the global series of 781 patients with T1-T2 prostate cancer treated by means of radical prostatectomy between 1990 and 2004, we study 108 with a Gleason score on the biopsy of 8-10. Median PSA was 12 ng/ml and 50% were T2. Variables related to biochemical progression and progression free survival have been studied, comparing the group of Gleason 8-10 with the rest and analyzing, within the Gleason 8-10 group which are the related variables with progression and progression free survival, trying to find a predictive model. Contingency tables and logistic regression have been employed. For the survival analysis, Kaplan Meyer curves, log-rank and Cox models. RESULTS Actual State: 62.7% (490/781) are alive and free of biochemical progression, 24.8% (194/781) are alive with biochemical progression, 2.9% (23/781) are dead by cancer and 1.9% (15/781) are dead by other cause and 7.6% (59/781) are lost. Biochemical progression study of the whole series (781 patients) Clinical Gleason score 8-10 is a influence factor on the univariate study (OR2,61 IC 95%: 1.7-4). In the progression free survival study (PFS) of the whole series (781 patients) the PFS in Clinical Gleason 8-10 at 3 and 5 years is 56 +/- 5% y 35 +/- 7%, significantly worse than the rest of the group (p < 0.0001). In the multivariate study of the influence factors on the PFS includes Clinical Gleason Score 8-10 as an independent prognostic factor (OR: 2.6 IC 95%: 1.6-4.12) p = 0.003, together with the clinical stage (OR: 1.,81 IC 95%: 1.18-2.78) p < 0.006, the PSA (OR: 1.03 IC 95%: 1.025-1.046) p < 0.0001 and the side of tumor on the biopsy (OR: 1.5 IC 95%: 1.01-2.24) p = 0.045. In the clinical Gleason score 8-10 group the influent factors on the PFS are. PSA (OR: 1.02 IC 95%: 1.003-1.04) and pathological stage (OR: 3.84 IC 95%: 1.77-8.27). Patients with a pT2 have a significantly better survival than those pT3 at 3 and 5 years (80 +/- 6%; 54 +/- 13% y 40 +/- 7%; 27 +/- 7%) (p < 0.0001). The best cut point for the PSA is 11 ng/ml. Patients with a PSA < 11 ng/ml have a 3 and 5 years survival better than those with >11 ng/ml PSA (74 +/- 7%, 30 +/- 22% y 40 +/- 7%, 26 +/- 7%) (p < 0.0001). CONCLUSIONS Clinical Gleason Score 8-10 is a negative independent prognostic factor on the progression free survival, but its prognosis is better if they present a PSA prior surgery lower than 11 ng/ml and the pathological stage is a pT2.Resumen Adenocarcinoma de prostata gleason clinico 8-10: influencia pronostica en la supervivencia libre de progresion bioquimica Objetivo Analizar las caracteristicas del grupo de pacientes con Adenocarcinoma de prostata Gleason clinico 8-10 en nuestra serie tratados mediante prostatectomia radical, e intentar averiguar que factores dentro del grupo influyen en la progresion y supervivencia libre de progresion Material y Metodos De una serie de 781 pacientes con Cancer de Prostata T1-T2, tratados con Prostatectomia Radical entre 1990-2004, estudiamos 108 con Gleason clinico 8-10. Mediana de PSA de 12 ng/ml, el 50% era T2 Se han estudiado las variables relacionadas con la progresion bioquimica y la supervivencia libre de progresion bioquimica, comparando el grupo Gleason 8-10 con el resto y analizando dentro del grupo Gleason 8-10 las variables relacionadas con la progresion y Supervivencia libre de progresion, buscando un modelo predictivo. Se han utilizado tablas de contingencia y regresion logistica. Para el analisis de la supervivencia, Kaplan-Meyer, log-rank y modelos de Cox Resultados En el estudio de progresion bioquimica de la totalidad de la serie (781 pacientes). El Gleason clinico 8-10 es un factor influyente en el estudio univariado (OR:2,61 IC 95%: 1,7-4) En el estudio de supervivencia libre de progresion (SLP) de la totalidad de la serie (781 pacientes) la SLP de los Gleason clinico 8-10 a 3 y 5 anos es de 56 ± 5% y 35±7%, significativamente peor que la del resto del grupo (p Dentro del Grupo Gleason Clinico 8-10 los factores influyentes en la SLP son: el PSA (OR:1,02 IC 95%:1,003-1,04), y el estadio patologico (OR:3,84 IC 95%: 1,77-8,27). Los pacientes pT2 tienen una supervivencia significativamente mejor que los pT3 a 3 y 5 anos (80±6%; 54±13% y 40±7%; 27±7%) (p 11 ng/ml (74±7%, 30±22% y 40±7%,26±7%)(p Conclusion El gleason clinico 8-10 es un factor negativo de influencia independiente en la supervivencia libre de progresion, pero su pronostico es mejor si presentan un PSA previo

Poliartritis secundaria a instilaciones intravesicales de BCG, a propósito de un caso

POLYARTHRITIS SECONDARY TO INTRAVESICAL BCG INSTILLATION, A CASE REPORT Immunotherapy with intravesical instillation of Bacillus Calmette is the best complementary after TUR treatment against T1 grade 2- 3 and CIS bladder cancer. However, this therapy is associated with several side- effects, incluiding joint symptoms. In this article we describe a case of polyarthritis associated with intravesical instillation, a rare complication. We review the clinical features, the pathogenic mechanisms and treatments described previously in the medical literature. Finally, we expose our brief experience and our final result.

Adrenalectomía laparoscópica por metástasis metácrona: Experiencia en 12 casos

RESUMEN Objetivos Evaluar los resultados perioperatorios y oncologicos de la adrenalectomia laparoscopica por metastasis aislada. Material y metodos Estudio retrospectivo y descriptivo de 12 adrenalectomias laparoscopicas por metastasis de un total de 40 realizadas entre mayo de 1998 y abril de 2009. El tumor primario fue en siete casos de pulmon, en tres renal y en dos de colon. Los datos demograficos de la serie incluyeron edad, tiempo operatorio, sangrado, complicaciones, tamano tumoral y estancia hospitalaria expresados como mediana. El analisis de supervivencia se hizo con el metodo de Kaplan-Meier. Resultados El tiempo operatorio fue de 150 minutos (rango 90 a 206). El sangrado intraoperatorio fue de 60 cc (rango 15 a 150). Hubo complicaciones intraoperatorias en el 3% de los casos. El tamano tumoral fue de 4,5 cm (rango 1,3 a 8,5). No se observaron margenes positivos en las piezas de reseccion. La estancia hospitalaria fue de tres dias (rango 3 a 5). La supervivencia actuarial fue del 55,6% a los 23 meses (rango 2 a 38), con una media y mediana de seguimiento de 20,9 y 23 meses, respectivamente. Conclusiones La adrenalectomia laparoscopica por metastasis en pacientes seleccionados es una tecnica segura con resultados oncologicos superponibles a los de la cirugia abierta.

Cáncer de próstata localizado de alto riesgo tratado mediante prostatectomía radical: Pronóstico y estudio de variables influyentes

Background. To study the biochemical progression-free survival (BPFS) achieved by a group of high risk patients in accordance with D’Amico’s classification treated with radical prostatectomy. To identify the clinical-pathological variables which are influential in biochemical progression-free survival and, if possible, use them to design a prognostic model. Material and methods. The study involves 232 patients, out of a series of 1,054, diagnosed with clinically localized prostate cancer, qualified as high risk on D’Amico’s classification (PSA>20 ng/ml or Gleason score 8-10 or T3) treated with radical prostatectomy. The BPFS is studied and the clinical-pathological variables obtained (PSA, Gleason score of the biopsy and of the piece, clinical and pathological study, unilateral or bilateral affectation, margins of the prostatectomy piece, Ki-67 expression) are analyzed to identify whether they influenced the BPFS. Contingency tables and tables for survival analysis: Kaplan-Meyer, log-rank and Cox models were used for the statistical study. Results. Descriptive study: PSA: 23.3 ng/ml (median); cGleason 2-6: 33%; 7: 13%; 8-10: 54%; T2: 58%; Bilateral affectation in the diagnostic biopsy: 59%; RNM T2: 60%; RNM T3: 40%. pGleason 2-6: 24%; 7: 28%; 8-10: 48%; pT2: 43%; pT3a: 30%; pT3b: 27%; Affected margin: 51%; N1:13%. Progression-free survival: with a mean and median follow-up of 64 months; 53% show biochemical progression. The median until progression: 42 months. Progression-free survival at 5 and 10 years is 43±3% and 26±7%. The multivariate study (Cox models) shows that the variables that are independently influential in the BPFS are the affectation of margins (HR: 3.5; 95% IC.1.9-6.7; p 10% (HR: 2.3; 95% IC: 1.2-4.3; P: 0.009). Risk groups: using the two influential variables and employing Cox models, three risk groups emerged as the best model: Group 1 (0 variables present); Group 2 (1 variable); Group 3 (2 variables). The progression-free survival is 69±8%; 27±6% and 18±11% at 5 years. The differences amongst the three groups are significant. Conclusion. The high risk group according to the D’Amico classification is heterogeneous in relation to biochemical progression and can be broken down into three risk groups using the two independently influential variables (affected margins and Ki67 percentage).