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To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for deterioration in kidney function.Retrospective study of patients with two kidneys, glomerular filtration rate (GFR)60 mL/min/1.73 mA total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated by RN and 216 (58.1%) by PN. There was a difference of 26.75 mL/min/1.73 mRN is a short- and long-term risk factor for CKD, although with a low probability of severe CKD or ESRD in patients with preoperative GFR60 mL/min/1.73 m

Objective Survival analysis of patients with prostate cancer (PCa) with adverse prognostic factors (APF) treated with radical prostatectomy (RP) and salvage radiotherapy (SRT) after biochemical recurrence (BR) or biochemical persistence (BP). Materials and methods Retrospective analysis of 446 patients with at least one of the following APF: Gleason score ≥8, pathologic stage ≥pT3 and/or positive surgical margins. BR criteria used was PSA level over 0.4 ng/ml. A survival analysis using Kaplan–Meier was performed to compare the different variable categories with log-rank test. In order to identify risk factors for SRT response and cancer specific survival (CSS) we performed univariate and multivariate analyses using Cox regression. Results Mean follow up: 72 (IQR 27–122) months, mean time to BR: 42 (IQR 20–112) months, mean PSA level at BR: 0.56 (IQR 0.42–0.96). BR was present in 36.3% of the patients. Biochemical response to SRT was observed in 121 (75.7%) patients. Recurrence-free survival (RFS) rates after SRT at 3, 5, 8 and 10 years were 95.7%, 92.3%, 87.9%, and 85%; overall survival (OS) rates after 5, 10 and 15 years was 95.6%, 86.5% and 73.5%, respectively. CSS rates at 5, 10 and 15 years were 99.1%, 98.1% and 96.6%. Only time to BR Conclusions In these patients, RP only controls the disease in approximately half of the cases. Multimodal sequential treatment (RP + SRT when needed) increases this control, achieving high CSS rates and biochemical control in over 87% of the patients. Patients with time to recurrence >24 months responded better to rescue treatment.

Introduction Recurrence trends after renal cell cancer (RCC) nephrectomy are not clearly defined. Objective To evaluate recurrence trends according to recurrence risk groups (RRG). Methods Retrospective analysis of 696 patients with RCC treated with nephrectomy between 1990−2010. Three RRG were defined according to the presence of anatomopathological variables (pTpN stage, nuclear grade, tumor necrosis (TN), sarcomatoid differentiation (SD), positive resection margin (RM)): - Low RG (LRG):pT1pNx-0 G1–4, pT2pNx-0 G1–2; no TN, SD and/or RM(+) - Intermediate RG (IRG):pT2pNx-0 G3–4;pT3–4pNx-0 G1–2; LRG with TN. - High RG (HRG):pT3–4pNx-0 G3–4;pT1–4pN+;IRG with TN and/or SD; LRG with SD and/or RM (+). The Kaplan-Meier method has been used to evaluate recurrence-free survival as a function of RRG. The log-rank test was used to evaluate differences between survival curves. Results The median follow-up was 105 (IQR 63–148) months. Of the total series, 177 (25.4%) patients presented recurrence: distant 15.9%, local 4.9% and 4.6% distant and local. The recurrence rate varied according to the RRG with values of 72.9% for HRG, 16.9% for IRG and 10.2% for LRG (P = .0001). Most cases in LRG presented single organ recurrence (72.2%) (P = .006). The LRG experienced recurrence as single metastasis in 50% of cases, compared to 30% and 18.6% in IRG and HRG, respectively (P = .009). The most common sites of recurrence were lung and abdomen. Lung recurrence predominated in the HRG (72.9%) (P = .0001) and abdominal, in the LRG (83.3%) with a tendency to significance (P = .15). Conclusions Recurrence rates (especially bone and lung) increase with higher RG. Single organ recurrences and single metastases are more frequent in LRG.

Objective Based on preoperative clinical and postoperative pathological variables, we aim to build a prediction model of cancer specific mortality (CSM) at 1, 3, and 5 years for patients with bladder transitional cell carcinoma treated with RC. Material and methods Retrospective analysis of 517 patients with diagnosis of cell carcinoma treated by RC (1986–2009). Demographic, clinical, surgical and pathological variables were collected, as well as complications and evolution after RC. Comparative analysis included Chi square test and ANOVA technique. Survival analysis was performed using Kaplan–Meier method and log-rank test. Univariate and multivariate analyses were performed using logistic regression to identify the independent predictors of CSM. The individual probability of CSM was calculated at 1, 3 and 5 years according to the general equation (logistic function). Calibration was obtained by the Hosmer–Lemeshow method and discrimination with the elaboration of a ROC curve (area under the curve). Results BC was the cause of death in 225 patients (45%); 1, 3 and 5-year CSM were 17%, 39.2% and 46.3%, respectively. The pT and pN stages were identified as independent prognostic variables of CSM at 1, 3 and 5 years. Three prediction models were built. The predictive capacity was 70.8% (CI 95% 65–77%, p = .000) for the 1st year, 73.9% (CI95% 69.2–78.6%, p = .000) for the third and 73.2% (CI% 68.5–77.9%, p = .000) for the 5th year. Conclusions The prediction model allows the estimation of CSM risk at 1, 3 and 5 years, with a reliability of 70.8%, 73.9% and 73.2%, respectively.

Introduction and objectives The AEU Guidelines of 2017 consider laparoscopic and robot-assisted approaches as investigational procedures. The surgical learning curve is defined as the minimum number of cases that a surgeon has to perform in order to reproduce a technique considered as standard. The aim of this study is to analyze, within our department, the implementation of a laparoscopic radical cystectomy (LRC) program compared with a well consolidated and standardized open radical cystectomy (ORC) program. Material and methods Retrospective cohort analysis of two cystectomy groups: LRC (n = 196) (20062016) vs ORC (n = 96) (2003–2005). Comparison of the evolution over time of the following parameters: operative time, blood transfusion rates, resection margins, postoperative complications, hospital stay and recurrence. Three time periods have been defined for LRC: implementation (2006–09) (LRC-I), development (2010–14) (LRC-D) and consolidation (2015–16) (LRC-C); comparing each of them with the control group (ORC). The chi-square test was used for the comparison of the qualitative variables and the Anova test for the numerical ones. Results When compared to ORC, LRC presented longer operative times in LRC-I and LRC-D periods. We observed a trend toward shorter operative time than ORC in the consolidation period (LRC-C). LRC also presented lower intraoperative transfusion rates in all periods and lower postoperative rates in CRL-D and CRL-C. Overall complications in LRC-D and LRC-C were lower in LRC, having fewer major complications (Clavien ≥ 3) in the 3 periods. A decrease in mortality and hospital stay after the LRC-I phase was also observed. These results were consolidated during the two last periods of the study. We have not observed significant differences between ORC and LRC when comparing surgical margins and recurrence rates, neither in the total series, nor in the comparison between the different periods. These results endorse the oncologic safety of LRC from the beginning of the implementation process. Conclusions When compared to ORC, LRC improves perioperative transfusion rates, complications and hospital stay from its implementation period, maintaining oncological safety. On the contrary, longer operative times during implementation and development were observed. However, in our series, we observed a trend toward shorter operative times than ORC approach in the consolidation period. We have validated the laparoscopic approach for radical cystectomy in our service.

Introduction There is no consensus on the follow-up protocol after nephrectomy for renal cell carcinoma (RCC), and the identification of recurrence risk groups (RRG) is required. Objective Establish recurrence risk groups (RRG). Material and methods A retrospective analysis of 696 patients with renal cancer submitted to surgery between 1990 and 2010; 568 (81.6%) patients treated with radical nephrectomy and 128 (18.4%) treated with partial nephrectomy. Pathological variables were classified as: 1st-level variables (1LPV): pTpN stage and Fuhrman grade (FG); and 2nd level pathological variables (2LPV): sarcomatoid differentiation (SD), tumor necrosis (TN), microvascular invasion (MVI) and positive surgical margins (PSM). Univariate and multivariate analysis have been performed using Cox regression to determine 1LPV related to recurrence. Based on 1LPV, we classified patients into three RRG: Low (LRG) 50%. We performed univariate and multivariate analysis with the 2LPVs for each RRG. With these data, patients were reclassified as RRG +. ROC curves were used for comparison of RRG and RRG+. Results The median follow-up was 105 months (range 63–148). There were 177 (25.4%) patients with recurrence: 111 (15.9%) distant, 34 (4.9%) local and 32 (4.6%) distant and local. In the multivariable analysis, Fuhrman grade HR = 2,75; p = 0,0001 and pTpN stage HR = 2,19;p = 0,0001 behaved as independent predictive variables of recurrence. Patients were grouped as RRG AUC = 0,76; p = 0,0001: - LRG (pT1pNx-0 G1-4; pT2pNx-0 G 1-2 ): 456 (65.5%) patients. - IRG (pT2pNx-0 G 3-4 ; pT 3-4 pNx-0 G 1-2 ): 110 (15.8%) patients. - HRG (pT 3-4 pNx-0 G 3-4 ; pT1-4pN+): 130 (18.6%) patients. After multivariate analysis with 2LPV, RRG were reclassified RRG+ AUC = 0,84, p = 0,0001: -LRG+ (LRG without TN, SD and/or PSM(+)) -IRG+ (IRG; LRG with TN) -HRG+ (HRG; LRG with SD and/or PSM(+); IRG with TN and/or SD) Conclusion The inclusion of 2LPV to the classification according to VP1N improves the discriminating capacity of RRG classification.

Introduction Minimally invasive surgery regarding cystectomy has not had the same development as other urological surgeries. This could be due to the lack of published studies defining the advantages of this approach versus open surgery. Objectives The main objective of this study is to establish the role of minimally invasive surgery, laparoscopic radical cystectomy, versus open surgery by analyzing their perioperative complications. Material and method Retrospective cohort analysis of perioperative complications of 2 homogeneous series of cystectomies: laparoscopic (n = 196) versus open (n = 197). Identification of independent predictors of perioperative complications by multivariate analysis. Results In the comparative analysis between laparoscopic cystectomies and open cystectomies we observed a lower rate of perioperative blood transfusion (p 3; p Conclusions We have identified the laparoscopic approach as a complication shield for radical cystectomy. The open approach almost triples the risk of complications.

Introduction and objective Minimally invasive surgery represents an attractive surgical approach in radical cystectomy. However, its effect on the oncological results is still controversial due to the lack of definite analyses. The objective of this study is to evaluate the effect of the laparoscopic approach on cancer-specific mortality. Material and method A retrospective cohort study of two groups of patients in a pT0-2pN0R0 stage, undergoing open radical cystectomy (ORC) (n = 191) and laparoscopic radical cystectomy (LRC) (n = 74). Using Cox regression, an analysis has been carried out to identify the predictor variables in the first place, and consequently, the independent predictor variables related to survival. Results 90.9% were males with a median age of 65 years and a median follow-up period of 65.5 (IQR 27.75–122) months. Patients with laparoscopic access presented a significantly higher ASA index (p = 0.0001), a longer time between TUR and cystectomy (p = 0.04), a lower rate of intraoperative transfusion (p = 0.0001), a lower pT stage (p = 0.002) and a lower incidence of infection associated with surgical wounds (p = 0.04). When analyzing the different risk factors associated with cancer-specific mortality, we only found the ORC approach (versus LRC) as an independent predictor of cancer-specific mortality (p = 0.007). Open approach to cystectomy multiplied the risk of mortality by 3.27. Conclusions In our series, the laparoscopic approach does not represent a risk factor compared to the open approach in pT0-2N0R0 patients.

Introduction and aim The main aim of the study was to establish the oncological safety of the laparoscopic approach to radical cystectomy for high-risk, non-organ-confined urothelial tumours. Material and methods A retrospective cohort study of 216 stage pT3-4 cystectomies operated between 2003 and 2016; using an open approach (ORC, n = 108), and using a laparoscopic approach (LRC, n = 108). Results Both groups have similar pathological features except, in G3 TUR, there were more lyphadenectomies and greater pN+, and more adjuvant chemotherapies using the LRC. The median follow-up of the series was 15 (IQR: 8–10.5) months. Sixty-eight point one percent of the series relapsed, with no differences between either group (p = 0.11). The estimated differences for cancer-specific survival was greater in the LRC group (p = 0.03), as was overall survival (p = 0.009). There were no differences between either group in estimated recurrence-free survival (p = 0.26). The type of surgical approach (p = 0.03), pTpN stage (p = 0.0001), and administration of adjuvant chemotherapy (p = 0.003) were related to cancer-specific mortality (CSM) in the univariate analysis. Only the pTpN stage (p = 0.0001), and not giving adjuvant chemotherapy (p = 0.003) behaved as independent predictive factors of CSM. Conclusion The type of surgical approach to cystectomy (ORC vs. LRC) did not influence CSM. Lymph node involvement and not giving adjuvant chemotherapy were identified as predictive factors of CSM. Our study supports the oncological safety of the laparascopic approach for cystectomy in patients with locally advanced muscle-invasive bladder tumours.

Context Bladder cancer is the cause of more than 150,000 deaths per year. The overall rate of survival is approximately 45%, with a 10-year recurrence-free rate of 50–59%, with no changes in the last decade. Objective Due to a lack of agreement on the follow-up of cystectomy or on a uniform treatment when faced with the various types of recurrence, we have analyzed the most recent literature in an attempt to unify the criteria for the diagnosis and treatment of bladder cancer. Acquisition of evidence Review of Spanish and English publications in the medical literature in the last 10 years, highlighting the most significant series in terms of the number of patients, follow-up time, as well as the existing meta-analyses. Synthesis of the evidence Recurrence after cystectomy can occur in the urinary apparatus (upper urinary tract or distal urethra) and local (cystectomy bed) and/or distant metastases. Despite strict control, more than 60% of the relapses are discovered based on symptoms and not by the routine follow-up test. Locoregional and distant relapses are more common the more advanced the stage at the time of cystectomy, going from 11–21% in pT2N0 to 52–72% when there is lymphocytic N+ involvement. Recurrence in the urethra and/or upper urinary track has other prognostic factors such as multiplicity, the presence of Cis and involvement of prostatic stroma. There are various treatments for tumor relapses. Increasingly, the patient's comorbidity is considered when deciding on the therapeutic strategy. Treatments are typically multimodal and include surgery, radiotherapy and chemotherapy. Conclusion The follow-up of patients who undergo cystectomy should be individualized, taking into account the prognostic factors of recurrence and the patient's comorbidity, assuming that in some cases, multimodal treatment is indicated.