José Ignacio Costabel

Functional and oncologic outcomes after nephron-sparing surgery in a solitary kidney: 10 years of experience

ABSTRACT Objectives: To evaluate functional and oncologic outcomes of partial nephrectomy (PN) in patients with a solitary kidney. Materials and Methods: A retrospective analysis of patients with a solitary kidney undergoing nephron-sparing surgery between March 2003 and March 2013 was performed. GFR was recorded before the procedure and 3 months after surgery, thus establishing a change (cGFR). Several variables that may influence cGFR were analyzed. Complications are herein described, namely bleeding, fistula, acute renal failure and end-stage renal disease (ESRD). Local recurrence and margin status are also described. Survival rates were calculated using the Kaplan Meier method (2 patients with metastasis at the time of surgery were excluded from the analysis). Results: Forty-five patients were available for analysis. Median follow-up was 27.56 months (r 3-96). Mean cGFR was-7.12mL/min (SD 2.1). Variables significantly related with lower GFR after surgery were loss of renal mass (p=0.01)) and male gender (p=0.03). Four patients (8.8%) experienced hemorrhage. Nine patients (20%) developed a urinary fistula. Only one patient with bleeding required open surgery. Two patients (4.4%) needed transient dialysis. Three patients (6.6%) developed ESRD. Four patients (8.8%) had positive surgical margins (PSMs) and four patients (88%) had local recurrence (2 of these had PSMs). Five patients (11.1%) died during follow-up. Four patients (8.8%) died because of renal cancer. Estimated 2-year overall survival, disease-free survival and cancer specific survival rates were 88.4% (CI 95% 70.5-96); 87.7% (CI 95% 68.1-96) and 92.4% (CI 95% 75-98), respectively. Conclusion: Loss of renal mass and male gender were associated with lower postoperative GFR. Our outcomes were comparable with those in the World literature.

La incidencia de márgenes quirúrgicos positivos tras prostatectomía radical asistida por robot: ¿tiene la experiencia del cirujano influencia en todos los estadios patológicos?

OBJECTIVE The aim of this study is to analyze the clinical and surgical features of patients who underwent robotic-assisted radical prostatectomy (RARP) at our institution, and the impact of the surgeons experience in the oncological results related to pathological stage. MATERIAL AND METHODS An analysis of 300 RARP consecutively performed by the same urologist was conducted. Patients were divided into 3 groups of 100 patients in chronological order, according to surgery date. All patients had organ-confined clinical stage. Variables which could impact in positive margins rates were analyzed. Finally, positive surgical margins (PSM) in regard to pathological stage and surgeons experience were compared and analyzed. RESULTS No significant differences were found in variables which could impact in PSM rates. The overall PSM rate was 21%, with 28% in the first group, 20% in the second, and 16% in the third (P = .108). Significant lineal decreasing tendency was observed (P = .024). In pT2 patients, the overall PSM rate was 16.6%, with 27%, 13.8%, and 7.3% in each group respectively (P = .009). A significant difference was found between group 1 and group 3 (P = .004). In pT3 patients, the surgeons experience was not significantly associated with margin reductions with an overall PSM rate of 27.7% (28.2%, 28.6%, and 26.7% in each group respectively). CONCLUSIONS Clinical and surgical features in our patients did not vary over time. We found a significant reduction of PSM related to surgeons experience in pT2 patients. Contrariwise, the margin status remained stable despite increasing experience in pT3 patients.