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"apellidos" => "Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480614000461" "doi" => "10.1016/j.acuro.2014.02.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480614000461?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614001620?idApp=UINPBA00004N" "url" => "/21735786/0000003900000001/v1_201501230116/S2173578614001620/v1_201501230116/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173578614001577" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2014.11.006" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "657" "copyright" => "AEU" "documento" => "article" "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2015;39:2-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 299 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 136 "PDF" => 155 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Clinical presentation features of testicular cancer in public hospitals in the Autonomous Community of Madrid, Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "2" "paginaFinal" => "7" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características de la forma de presentación del cáncer de testículo en hospitales públicos de la Comunidad Autónoma de Madrid, España" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Moreno, A. Domínguez, C. Alpuente, A. Hernándo, J. Torres, J.A. Cabrera" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Moreno" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Domínguez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Alpuente" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Hernándo" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Torres" ] 5 => array:2 [ "nombre" => "J.A." 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Rodríguez-Faba, J. Palou, A. Rosales, P. de la Torre, J. Martí, A. Palazzetti, H. Villavicencio" "autores" => array:7 [ 0 => array:4 [ "nombre" => "O." "apellidos" => "Rodríguez-Faba" "email" => array:1 [ 0 => "orodriguez@fundacio-puigvert.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Palou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Rosales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "de la Torre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Martí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Palazzetti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "H." "apellidos" => "Villavicencio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Urooncología, Fundació Puigvert, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urología, Fundació Puigvert, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio prospectivo de crioterapia renal percutánea ecoguiada: selección de casos como factor de optimización de una técnica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1722 "Ancho" => 1554 "Tamanyo" => 75447 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier curve of overall survival.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The extensive use of ultrasound scans and CT in recent years has increased by 60% the incidental diagnosis of small renal masses (≤4<span class="elsevierStyleHsp" style=""></span>cm).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, many of such lesions are benign ones and are diagnosed in people over the age of 70. Besides, most of them behave in an asymptomatic manner with a growth rate of 3–4<span class="elsevierStyleHsp" style=""></span>mm/year.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Active surveillance in these cases through a series of imaging tests is an option for elderly patients or those with comorbidity, but it is not free of financial cost, and sometimes of a psychological impact on the patient.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Still, in younger patients, partial nephrectomy for stage T1a is the standard indication for treatment.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cryotherapy (CT) is considered as a minimally invasive technique allowing to better preserve renal function and to minimize complications arising from major surgery in these cases. At our center, we have gained extensive experience with laparoscopic cryotherapy (LC) in monorenal patients, or with previous surgery for renal tumors or in high-surgical-risk patients. Results showed a low percentage of complications.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is for this reason that we considered that posterior tumors and those in the outer inferior edge could benefit from a less invasive percutaneous approach, so a prospective study was designed to assess the technical and oncological efficiency of PC in a selected group of patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Since October 2008, we conducted a prospective study approved by the hospital ethics committee. All patients were informed about the details of the technique, therapeutic alternatives (partial and radical nephrectomy) and signed informed consent forms.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Inclusion criteria were as follows: renal masses<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm, located in the posterior side and in the inferior or middle edge of the kidney, masses in the anterior side and in the outer edge (only those in the lower polar region). Exclusion criteria were cystic renal masses or in the anterior side or upper pole, and masses showing in the radiological study irresolvable contact with peritoneal structures, the liver, the spleen or the pleura. Postoperative complications were collected and classified according to the Clavien-Dindo classification system.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> A descriptive survival study was done using Kaplan–Meier methods.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical technique</span><p id="par0035" class="elsevierStylePara elsevierViewall">Access to the kidney was performed through an echo-guided percutaneous approach by the interventional surgery service, and assisted by an urologist throughout the entire procedure; preoperative ultrasound was performed in all cases to confirm the existence of good access to the kidney and tumor visualization. A renal biopsy was also performed in all cases. CRYOcare™ equipment (Endocare<span class="elsevierStyleSup">®</span>) was used by applying a double freezing cycle<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>: a first freezing cycle for 12–20<span class="elsevierStyleHsp" style=""></span>min, until the tip of the cryoprobe reaches from −185<span class="elsevierStyleHsp" style=""></span>°C to −195<span class="elsevierStyleHsp" style=""></span>°C and then a passive defrosting process. Subsequently, a second similar cycle until the cryoprobe reaches 8–10<span class="elsevierStyleHsp" style=""></span>°C, at this moment it is removed.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Follow-up</span><p id="par0040" class="elsevierStylePara elsevierViewall">Within the first 24 postoperative hours, follow-up ultrasound was performed in all patients. Follow-up was conducted with CT after a month, and subsequently every 6 months. The radiological definition of good outcome was considered as the complete absence of contrast in the treated area. In the event that the lesion showed increased size or absence of gradual decrease, or the presence of vascularization (difference<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>15–20<span class="elsevierStyleHsp" style=""></span>HU<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>), the case was considered as therapeutic failure and a new percutaneous cryoablation was considered.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patients’ characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Twenty-eight procedures were performed in a total of 28 patients with a mean age (MA) of 68.3 (10.1) years. The mean (SD) body mass index (BMI) was 26.6<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (5.9). The mean (SD) Charlson comorbidity index was 2.4 (1.3) and the mean preoperative creatinine 133.5<span class="elsevierStyleHsp" style=""></span>mmol/l (144.1). Tumor characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The mean (SD) size was 25.5<span class="elsevierStyleHsp" style=""></span>mm (7.5), and the mean nephrometry score 1.41 (0.52).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Preoperative and postoperative characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. The mean (SD) operative time was 157<span class="elsevierStyleHsp" style=""></span>min (57) and the mean (SD) hospital stay 2.71 days (1.84). There were no cases of intraoperative complications; regarding postoperative complications there was only one case (3.5%) of skin lesion in a transplant patient, who underwent percutaneous cryotherapy on the renal graft (Clavien II), and who required analgesic and antibiotic therapy.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">All patients underwent a preoperative biopsy, with a result of renal tumor in 26 cases (92.8%) and insufficient tissue for diagnosis in two cases (7.1%) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The mean follow-up was 25 months. The mean (SD) postoperative creatinine during this mean follow-up time was 135.5<span class="elsevierStyleHsp" style=""></span>mmol/l (110.3). Of the 28 patients, two cases (7.1%) showed radiological recurrence of the disease, which implies a treatment effectiveness of 93% (2/28), with time to recurrence of 12 and 19 months respectively. Both cases were treated with another session of cryoablation. No tumor-related death occurred (cancer-specific survival of 100%). There was a death due to other causes (overall survival of 96.5%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Minimally invasive renal cryotherapy can be performed through a laparoscopic and percutaneous approach. The EAU recommends the use of these ablative techniques in the case of patients with small tumors or who are not candidates for surgery.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the case of tumors in the anterior side, laparoscopy enables a direct visualization of the tumor, taking biopsies and performing an intraoperative ultrasound to directly visualize cryoball size.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> There are already long-term oncological results for LC.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">PC offers greater advantages in the case of tumors in the posterior side, such as a lower transfusion rate and operative time, as well as a greater ease for retreatment.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Tumor location can be assessed using ultrasound, CT or NMR. In our study, we decided to use ultrasound due to a greater availability and ease to be used by urologists, the extensive prior experience in echo-guided renal biopsy<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and the possibility of being able to control real-time formation and progression of the cryoball. The disadvantage with respect to laparoscopy is, for the time being, the lack of medium- and long-term oncological results. In this study we present what we consider to be the longest experience with PC in our country so far, with a mean follow-up time of 2 years.</p><p id="par0070" class="elsevierStylePara elsevierViewall">A meta-analysis with inclusion of 46 series (28 percutaneous and 18 surgical ones) concluded that the percutaneous approach is safer than the open or laparoscopic ones, with the same effectiveness, but with the disadvantage that sometimes more than one procedure is needed to completely treat the tumor.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> If we compare the laparoscopic and the percutaneous approaches, the published series show lower transfusion rates and a shorter hospital stay for the percutaneous approach, although with greater analgesic requirement.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Bandi et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> considered that PC in selected patients is associated with a shorter convalescence than laparoscopy, and Mues et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> in their series, confirmed a lower complication rate with no changes in renal function, even in patients with a single kidney.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In our study, the effectiveness rate was 93% with a mean follow-up of 26 months, which is in line with other studies conducted with a similar follow-up time, which show effectiveness rates of 87–96%.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–20</span></a> Differences in the effectiveness rate may be associated with some technical variations. Some groups<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> applied variable freezing times depending on cryoball growth. We used fixed cycles of 12–20<span class="elsevierStyleHsp" style=""></span>min ensuring a 5-mm margin of healthy parenchyma around the tumor. Vricella et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> performed an additional cycle depending on tumor size, since treating tumors >3<span class="elsevierStyleHsp" style=""></span>cm has been associated with a greater failure rate.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This is one of the arguments why we initially included smaller tumors (mean of 2.5<span class="elsevierStyleHsp" style=""></span>cm) achieving an effectiveness rate of 93%.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Like other groups,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a> in order to improve the visualization of the cryoball and to optimize probe placement, we conducted the procedure under general anesthesia.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Studies with a longer follow-up time than ours,<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,22</span></a> over 30 months, showed lower effectiveness rates (75–85%) with tumors of a similar size; although these studies conducted shorter freezing cycles. There are arguments in favor of the fact that longer freezing cycles offer higher success rates.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The careful selection of cases has meant a reduced complication rate which was limited to one case (3.5%) of cutaneous burn injury in a transplant patient who underwent cryoablation on the graft. The short distance between the skin and the tumor area to be treated led to a contact of the active cryoneedle with the skin; one must be cautious and the incision can be expanded to separate the skin or one can irrigate the area with hot saline. Previously published series reported complication rates of 4.6–8%.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,16</span></a> Apart from postoperative hematomas, cases of ureteral and duodenal fistulas were described and one case of postoperative bleeding which required embolization, all of them associated with tumors in the anterior side larger than 4<span class="elsevierStyleHsp" style=""></span>cm.</p><p id="par0095" class="elsevierStylePara elsevierViewall">To date, renal PC has not gained widespread recognition as a standard technique, probably due to the lack of long-term effectiveness results. Short- and medium-term results reveal that it can be an alternative, especially in patients who are not candidates for surgery and in older patients. To optimize results, and given our experience, the best results in terms of effectiveness and complications could be achieved with a percutaneous approach in posterior tumors and a laparoscopic one in anterior tumors. On the other hand, it enables a rapid recovery and a short hospital stay. Our study shows as its main limitation a limited number of cases and an intermediate follow-up time with respect to the published series.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,18</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Our initial experience, with a mean follow-up time of 2 years, showed that with an adequate selection of small tumors (≤4<span class="elsevierStyleHsp" style=""></span>cm) located in the posterior, lower and middle edges, PC is a really safe technique associated with minimal comorbidity. The use of ultrasound scans enables to perform the procedure with good control of size and cryoball location, without radiation or decrease in costs.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres413794" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec389459" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres413795" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec389458" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Follow-up" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-12-03" "fechaAceptado" => "2014-03-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec389459" "palabras" => array:4 [ 0 => "Cryotherapy" 1 => "Renal cancer" 2 => "Percutaneous" 3 => "Ultrasound-guided" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec389458" "palabras" => array:4 [ 0 => "Crioterapia" 1 => "Cáncer renal" 2 => "Percutánea" 3 => "Ecoguiada" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">To evaluate the technical and oncological effectiveness of ultrasound-guided percutaneous renal cryotherapy (PRC) in a selected group of patients with renal cancer.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">We conducted a prospective study of 28 patients with posterior-facing T1a renal tumors with middle and inferior external borders. All patients underwent ultrasound-guided PRC. Follow-up was conducted with computed tomography at 1 month and then every 6 months, with a good result defined as the total absence of contrast incorporation. We performed a descriptive and survival study using the Kaplan–Meier estimator.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The 28 patients had a mean age (SD) of 68.3 (10.1) years, and the group underwent 28 procedures. The mean (SD) size of the tumors was 25.5 (7.5)<span class="elsevierStyleHsp" style=""></span>mm, the mean nephrometry score was 1.41 (0.52) and the mean preoperative creatinine level was 133.5 (144.1)<span class="elsevierStyleHsp" style=""></span>mmol/L. There were no intraoperative complications. In terms of postoperative complications, there was only 1 case (3.5%) of a skin lesion resulting from treating a tumor in a transplanted kidney (Clavien II). The median follow-up was 25 months, and the mean (SD) postoperative creatinine level was 135.5 (110.3)<span class="elsevierStyleHsp" style=""></span>mmol/L. Two cases presented radiological recurrence (93% efficacy), with a mean time to recurrence of 12 and 19 months, respectively. There were no tumor-related deaths.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Our series (the largest on PRC in our country to date) shows that, with an appropriate selection of tumors, PRC is a safe technique with minimal morbidity. Ultrasonography enables the controlled performance of the procedure and saves the patient from radiation and reduces costs.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Evaluar la efectividad técnica y oncológica de la crioterapia renal percutánea (CP) ecoguiada en un grupo seleccionado de pacientes con tumor renal.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio prospectivo de 28 pacientes con tumores renales T1a de cara posterior y de borde externo medio e inferior. A todos se les realizó CP ecoguiada. El seguimiento fue con TC al mes y después cada 6 meses, considerándose como criterio de buen resultado la ausencia total de incorporación de contraste. Realizamos un estudio descriptivo y de supervivencia mediante Kaplan-Meier.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se trata de 28 pacientes con una edad media (DE) de 68,3 (10,1) años, en los que se realizaron 28 procedimientos. La media (DE) de tamaño fue de 25,5<span class="elsevierStyleHsp" style=""></span>mm (7,5) <span class="elsevierStyleItalic">nephrometry score</span> 1,41 (0,52) y creatinina preoperatoria 133,5<span class="elsevierStyleHsp" style=""></span>mmol/l (144,1). No hubo ninguna complicación intraoperatoria. Como complicaciones postoperatorias solo un caso (3,5%) de lesión cutánea al tratar un tumor en riñón trasplantado (Clavien II). La mediana de seguimiento fue de 25 meses, y la creatinina media (DE) postoperatoria fue de 135,5<span class="elsevierStyleHsp" style=""></span>mmol/l (110,3). Presentaron recurrencia radiológica 2 casos (eficacia del 93%), con un tiempo medio hasta la recurrencia de 12 y 19 meses respectivamente. No se produjo ninguna muerte relacionada con el tumor.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Nuestra serie, hasta el momento la más larga de CP en nuestro país, muestra que con una adecuada selección de tumores la CP es una técnica segura y con mínima morbilidad. La ecografía permite realizar el procedimiento de forma controlada, además de ahorrar irradiación y costes.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez-Faba O, Palou J, Rosales A, de la Torre P, Martí J, Palazzetti A, et al. Estudio prospectivo de crioterapia renal percutánea ecoguiada: selección de casos como factor de optimización de una técnica. Actas Urol Esp. 2015;39:8–12.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1722 "Ancho" => 1554 "Tamanyo" => 75447 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier curve of overall survival.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Patients</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Age (years), mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.3 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (85.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (14.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">BMI (kg</span>/<span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup">2</span>), <span class="elsevierStyleItalic">mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.6 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">BMI, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Preop creatinine (mmol/l) mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">133 (144.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Single kidney</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (14.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Tumor in renal transplant</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (7.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab644368.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Nephrometry score</span>, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1.41 (0.52) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Tumor size (mm), mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.5 (7.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Location (%)</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (35.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (57.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Renal graft \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Depth (%)</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>50% exophytic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>50% exophytic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fully endophytic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Location (%)</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anterior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Posterior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (53.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Upper \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lower \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (35.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Middle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Stage (%)</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>T1a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab644366.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the tumors.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">ASA n (%)</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (53.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (32.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Biopsy result n (%)</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clear cell \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Papillary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (32.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chromophobe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oncocytoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Undifferentiated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-viable tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Operative time (min), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">157.18 (57) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hospital stay (days), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.71 (1.84) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intraoperative complications (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Postoperative complications (%)</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clavien I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clavien II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean postop. creatinine (mmol/l) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">135.5 (110.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td 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