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Id: biblio-1001041
Autor: Gasparini-Junior, José Luiz; Fanelli, Marcello Ferretti; Abdallah, Emne Ali; Chinen, Ludmilla Thomé Domingos.
Título: Evaluating mmp-2 and tgfß-ri expression in circulating tumor cells of pancreatic cancer patients and their correlation with clinical evolution / Avaliação da expressão de mmp-2 e tgfß-ri em células tumorais circulantes de pacientes com câncer de pâncreas e sua correlação com evolução clínica
Fonte: ABCD arq. bras. cir. dig;32(2):e1433, 2019. tab, graf.
Idioma: en.
Projeto: FAPESP.
Resumo: ABSTRACT Background: Metastasis is common in the diagnosis of pancreatic cancer, and the presence of epithelial-mesenchymal transition markers in circulating tumor cells may suggest worse prognosis. Aim: To correlate the number of circulating tumor cells (CTCs) in the peripheral blood of patients with a locally advanced or metastatic pancreatic tumor and the protein expression involved in epithelial-mesenchymal transition (EMT) in CTCs with clinical characteristics, progression-free survival (PFS) and overall survival (OS). Method: This was a prospective study conducted using peripheral blood samples collected at three different times. CTCs were quantified by the ISET test and analyzed by immunocytochemistry. Proteins involved in EMT (vimentin, TGFß-RI and MMP2) were analyzed in all CTCs. Results: Twenty-one patients were included. Median CTCs detected were 22, 20 and 8 CTCs/8 ml blood at baseline, first and second follow-up, respectively. No statistically significant correlation was found in correlating the number of CTCs and the evaluated clinical characteristics, PFS, or OS. There was no difference in PFS and OS among the EMT markers in the groups with and without markers. Conclusion: CTC analysis was not relevant in this sample for comparing clinical findings, PFS and OS in patients with pancreatic cancer. However, marker analysis in CTCs could be useful for the MMP-2 and/or TGFß-RI expression, as observed by the separate PFS curve.

RESUMO Racional: A metástase é comum no diagnóstico de câncer de pâncreas; presença de marcadores de transição epitélio-mesenquimal nas células tumorais circulantes (CTCs) podem sugerir pior prognóstico. Objetivo: Correlacionar o número de CTCs no sangue periférico de pacientes com tumor de pâncreas localmente avançado ou metastático e expressão de proteínas envolvidas na transição epitélio-mesenquimal (TEM) nas CTCs com características clínicas, sobrevida livre de progressão (SLP) e global (SG). Método: Estudo prospectivo realizado por meio de coletas de sangue periférico em três tempos distintos. As CTCs foram quantificadas pelo sistema ISET e analisadas por imunocitoquímica. Proteínas envolvidas na TEM (vimentina, TGFß-RI e MMP2) foram analisadas em todas as CTCs. Resultados: Foram incluídos 21 pacientes. A mediana de CTCs detectadas foi de 22, 20 e 8 CTCs/8 ml de sangue no baseline, primeiro e segundo seguimentos, respectivamente. Na correlação entre número de CTCs e as características clínicas levantadas, SLP, SG não houve correlação estatisticamente significante. Nos marcadores de TEM não houve diferença de SLP e SG entre os grupos que apresentaram e não apresentaram marcação. Conclusão: As CTCs não se mostraram relevantes na comparação dos achados clínicos, SLP e SG em pacientes com câncer de pâncreas. No entretanto, pode ser que para a análise de marcador seja útil, como observado pelas curvas separadas de expressão de MMP-2 e TGFß-RI nas CTCs.
Descritores: Neoplasias Pancreáticas/sangue
Adenocarcinoma/sangue
Metaloproteinase 2 da Matriz/sangue
Receptor do Fator de Crescimento Transformador beta Tipo I/sangue
Células Neoplásicas Circulantes/química
-Neoplasias Pancreáticas/patologia
Valores de Referência
Fatores de Tempo
Vimentina/sangue
Adenocarcinoma/patologia
Biomarcadores Tumorais/sangue
Estudos Prospectivos
Progressão da Doença
Carga Tumoral
Estimativa de Kaplan-Meier
Transição Epitelial-Mesenquimal
Gradação de Tumores
Células Neoplásicas Circulantes/patologia
Estadiamento de Neoplasias
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Responsável: BR1.1 - BIREME


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Id: biblio-961411
Autor: Guevara, David Ladrón de; Pavez, Gonzalo; Zapata, Jaime; Romero, Claudio; Tapia, Valezka; Buckel, Erwin; Ferrario, Mario.
Título: Utilidad pronóstica del PET/CT en cáncer de páncreas / Prognostic value of PET/CT in pancreatic cancer
Fonte: Rev. méd. Chile;146(4):413-421, abr. 2018. tab, graf.
Idioma: es.
Resumo: Background: Pancreatic cancer is the tenth most prevalent cancer in world, and represents the fourth cause of cancer death. It has a five year-survival of 5%. Aim: To assess the prognostic value of PET/CT in pancreatic cancer. Material and Methods: Sixty-nine patients with pancreatic adenocarcinoma who underwent staging 18F-fluorodeoxyglucose (FDG) PET/CT between December 2008 and July 2016 were selected. Gender, age, body-mass index, laboratory tests (Ca 19-9, hemoglobin, erythrocyte sedimentation rate, liver enzymes, lactate dehydrogenase), histological differentiation of tumor, American Joint Committee on Cancer (AJCC) stage, size and 18F-FDG uptake (maximal stan-dardized uptake value [SUVmax]) of the primary tumor, nodal involvement and distant metastasis detected by PET/CT were registered. Survival was assessed using Kaplan-Meier curves, Log Rank test and Cox multivariable analysis. Results: Mortality was 66.7%, during a mean observation time of 18 months (range 20 days-66 months). Curative surgery, lack of metastases detected by PET/CT, histologically well differentiated tumors, and SUVmax ≤ 4.3 were significantly associated with a better specific survival, determined by the Log Rank test. Histological differentiation was the only variable that had a statistically significant prognostic value in the multivariable analysis. Conclusions: The detection of distant metastases and the intensity of primary tumor 18F-FDG uptake during PET/CT provide useful prognostic information in pancreatic cancer patients.
Descritores: Neoplasias Pancreáticas/diagnóstico por imagem
Adenocarcinoma/diagnóstico por imagem
-Neoplasias Pancreáticas/mortalidade
Neoplasias Pancreáticas/patologia
Prognóstico
Fatores de Tempo
Adenocarcinoma/mortalidade
Adenocarcinoma/patologia
Análise de Sobrevida
Estudos Retrospectivos
Seguimentos
Compostos Radiofarmacêuticos/administração & dosagem
Compostos Radiofarmacêuticos/farmacocinética
Fluordesoxiglucose F18/administração & dosagem
Fluordesoxiglucose F18/farmacocinética
Carga Tumoral
Gradação de Tumores
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos
Limites: Humanos
Masculino
Feminino
Pessoa de Meia-Idade
Idoso
Responsável: CL1.1 - Biblioteca Central


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Id: biblio-874981
Autor: Brasil. Ministério da Saúde. Comissão Nacional de Incorporação de Tecnologias no SUS.
Título: Terapia hormonal prévia e adjuvante à radioterapia externa no tratamento do câncer de próstata / Prior and adjunct hormone therapy to external beam radiation therapy in the treatment of prostate cancer.
Fonte: Brasília; CONITEC; 2015.
Idioma: pt.
Resumo: CONSIDERAÇÕES: A utilização de hormonioterapia em pacientes que irão submeter-se à radioterapia externa para tratamento de câncer de próstata localizado ou localmente avançado tornou-se a terapia padrão neste cenário clínico. A utilização de esquemas de supressão androgênica foi testada em diferente cenários em ensaios clínicos randomizados (ECR), variando também quanto ao momento de início da terapia, a duração da terapia e o momento de sua utilização, seja neoadjuvante (prévio), adjuvante ou ambos. Há benefício para hormonioterapia adjuvante à radioterapia no câncer de próstata de alto risco, tratamento a ser iniciado concomitantemente à irradiação, resultando em maior sobrevida livre de doença e impacto favorável em mortalidade câncer-específica e global. A duração da hormonioterapia adjuvante pode variar entre 6 - 36 meses, de acordo com a estratificação de risco do paciente e protocolo de tratamento adotado, porém o benefício foi maior nos tratamentos com duração superior a 24 meses. A hormonioterapia prévia à radioterapia pode ser realizada por período máximo de 3 meses quando for indicada, pois não há demonstração de vantagem clínica para uso mais prolongado. RECOMENDAÇÃO DA CONITEC: Os membros da CONITEC presentes na 31ª reunião ordinária do plenário do dia 04/12/2014, deliberaram por unanimidade por recomendar a incorporação dos procedimentos de hormonioterapia prévia e adjuvante à radioterapia externa no tratamento do câncer de próstata. DECISÃO: PORTARIA Nº 8, de 16 de março de 2015 - Torna pública a decisão de incorporar os procedimentos de hormonioterapia prévia e adjuvante à radioterapia externa no tratamento do câncer de próstata no âmbito do Sistema Único de Saúde - SUS.
Descritores: Neoplasias da Próstata/radioterapia
Radioterapia Adjuvante
Terapia de Reposição Hormonal
Recidiva Local de Neoplasia
-Sistema Único de Saúde
Brasil
Análise Custo-Benefício
Gradação de Tumores
Limites: Humanos
Masculino
Tipo de Publ: Relatório Técnico
Estudo de Avaliação
Responsável: BR1.1 - BIREME


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Id: lil-796878
Autor: Mussi, Thais Caldara; Garcia, Rodrigo Gobbo; Queiroz, Marcos Roberto Gomes de; Lemos, Gustavo Caserta; Baroni, Ronaldo Hueb.
Título: Prostate cancer detection using multiparametric 3 – tesla MRI and fusion biopsy: preliminary results
Fonte: Int. braz. j. urol;42(5):897-905, Sept.-Oct. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT Objective: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) biopsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clinically significant tumors according to histological criteria. Materials and Methods: A total of 189 consecutive US/MRI fusion biopsies were performed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria. Results: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively. There was a statistically significant difference in terms of biopsy results between different levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different levels of suspicion on mpMRI (p-value <0.05 in both analyzes). Conclusion: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI.
Descritores: Neoplasias da Próstata/patologia
Neoplasias da Próstata/diagnóstico por imagem
Imageamento por Ressonância Magnética/métodos
Biópsia Guiada por Imagem/métodos
-Próstata/patologia
Próstata/diagnóstico por imagem
Imageamento por Ressonância Magnética/instrumentação
Valor Preditivo dos Testes
Reprodutibilidade dos Testes
Estudos Retrospectivos
Antígeno Prostático Específico/sangue
Ultrassonografia de Intervenção/métodos
Estatísticas não Paramétricas
Gradação de Tumores
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Tipo de Publ: Estudo de Avaliação
Responsável: BR1.1 - BIREME


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Id: lil-796889
Autor: Otunctemur, Alper; Dursun, Murat; Ozer, Kutan; Horsanali, Ozan; Ozbek, Emin.
Título: Renal cell carcinoma and visceral adipose index: a new risk parameter
Fonte: Int. braz. j. urol;42(5):955-959, Sept.-Oct. 2016. tab.
Idioma: en.
Resumo: ABSTRACT Purpose: The aim of this study was to evaluate the relationship between tumor size and grade with visceral adipose index (VAI) levels in patients with renal cell carcinoma. Materials and methods: We retrospectively reviewed the records of 310 consecutive patients with RCC who underwent radical nephrectomy at our institution between January 2007 and May 2014. VAI was calculates for males and females seperately as this formula like previous study. The relationship between tumor size and nuclear grade with VAI levels were evaluated statisticaly. Analyses were completed using Chi-square tests and Logistic regression analysis. Results: Among the 310 total patients analyzed in our study, there were 176 males (56.8%) and 134 females (43.2%). VAI levels were statistically higher in men and women with high tumor size (p<0.001). VAI levels were statistically higher in men and women with high fuhrman grade (p<0.001). Conclusions: The components of VAI may have effect on tumor carcinogenesis in similar pathways. In our study patients with high VAI levels were found to have statistically significant higher nuclear grade and tumor size. VAI can be a useful index for the evaluation and calculation of renal cell cancer aggressiviness. Further studies with more patients are needed to confirm our study.
Descritores: Carcinoma de Células Renais/patologia
Medição de Risco/métodos
Carga Tumoral
Gordura Intra-Abdominal/patologia
Neoplasias Renais/patologia
-Índice de Massa Corporal
Modelos Logísticos
Fatores Sexuais
Estudos Retrospectivos
Fatores de Risco
Circunferência da Cintura
Gradação de Tumores
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Feminino
Idoso
Idoso de 80 Anos ou mais
Responsável: BR1.1 - BIREME


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Id: lil-796883
Autor: Almeida, Gilberto L; Busato J, Wilson F. S; Ribas, Carmen Marcondes; Ribas-Filho, Jurandir Marcondes; De Cobelli, Ottavio.
Título: External validation of EORTC risk scores to predict recurrence after transurethral resection of brazilian patients with non-muscle invasive bladder cancer stages Ta and T1
Fonte: Int. braz. j. urol;42(5):932-941, Sept.-Oct. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT Validate the EORTC risk tables in Brazilian patients with NMIBC. Methods: 205 patients were analyzed. The 6 parameters analyzed were: histologic grading, pathologic stage, size and number of tumors, previous recurrence rate and concomitant CIS. The time for first recurrence (TFR), risk score and probability of recurrence were calculated and compared to the probabilities obtained from EORTC risk tables. C-index was calculated and accuracy of EORTC tables was analyzed. Results: pTa was presented in 91 (44.4%) patients and pT1 in 114 (55.6%). Ninety-seven (47.3%) patients had solitary tumor, and 108 (52.7%) multiple tumors. One hundred and three (50.2%) patients had tumors smaller than 3 cm and 102 (40.8%) had bigger than 3 cm. Concomitant CIS was observed in 21 (10.2%) patients. Low grade was presented in 95 (46.3%) patients, and high grade in 110 (53.7%). Intravesical therapy was utilized in 105 (56.1%) patients. Recurrence was observed in 117 (57.1%) patients and the mean TFR was 14,2 ± 7,3 months. C-index was 0,72 for 1 year and 0,7 for 5 years. The recurrence risk was 28,8% in 1 year and 57,1% in 5 years, independently of the scoring risk. In our population, the EORTC risk tables overestimated the risk of recurrence in 1 year and underestimated in 5 years. Conclusion: The validation of the EORTC risk tables in Brazilian patients with NMIBC was satisfactory and should be stimulated to predict recurrence, although these may overestimated the risk of recurrence in 1 year and underestimated in 5 years.
Descritores: Neoplasias da Bexiga Urinária/cirurgia
Neoplasias da Bexiga Urinária/patologia
Medição de Risco/métodos
Recidiva Local de Neoplasia/patologia
-Fatores de Tempo
Brasil
Valor Preditivo dos Testes
Estudos Prospectivos
Reprodutibilidade dos Testes
Fatores de Risco
Progressão da Doença
Gradação de Tumores
Pessoa de Meia-Idade
Invasividade Neoplásica
Estadiamento de Neoplasias
Limites: Humanos
Masculino
Feminino
Idoso
Idoso de 80 Anos ou mais
Tipo de Publ: Estudo de Validação
Responsável: BR1.1 - BIREME


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Id: lil-794668
Autor: Feng, Lang; Song, Jian; Wu, Menghua; Tian, Ye; Zhang, Daoxin.
Título: Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience
Fonte: Int. braz. j. urol;42(4):655-662, July-Aug. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT Objective: This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients. Patients and Methods: A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed. Results: A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05). Conclusions: ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients.
Descritores: Neoplasias da Bexiga Urinária/cirurgia
Cistectomia/métodos
Laparoscopia/métodos
-Complicações Pós-Operatórias
Derivação Urinária/métodos
Neoplasias da Bexiga Urinária/patologia
Fotografação
Estudos Retrospectivos
Seguimentos
Resultado do Tratamento
Gradação de Tumores
Duração da Cirurgia
Excisão de Linfonodo
Estadiamento de Neoplasias
Limites: Humanos
Masculino
Idoso
Idoso de 80 Anos ou mais
Responsável: BR1.1 - BIREME


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Id: lil-785729
Autor: Okcelik, Sezgin; Soydan, Hasan; Ates, Ferhat; Berber, Ufuk; Saygin, Hasan; Sönmez, Güner; Karademir, Kenan.
Título: Evaluation of PCA3 and multiparametric MRI's: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL
Fonte: Int. braz. j. urol;42(3):449-455tab, graf.
Idioma: en.
Resumo: ABSTRACT Objective To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). Materials and Methods PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. Results 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. Conclusion Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.
Descritores: Próstata/patologia
Neoplasias da Próstata/patologia
Neoplasias da Próstata/diagnóstico por imagem
Imageamento por Ressonância Magnética
Antígeno Prostático Específico/sangue
Antígenos de Neoplasias/urina
-Tamanho do Órgão
Próstata/diagnóstico por imagem
Neoplasias da Próstata/urina
Valores de Referência
Biópsia
Valor Preditivo dos Testes
Estudos Prospectivos
Reprodutibilidade dos Testes
Fatores Etários
Medição de Risco
Exame Retal Digital/métodos
Gradação de Tumores
Tomada de Decisão Clínica
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Responsável: BR1.1 - BIREME


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Id: lil-785737
Autor: Bernardes, Julio.
Título: From robot to molecule, the behavior
Fonte: Int. braz. j. urol;42(3):409-412tab.
Idioma: en.
Descritores: Neoplasias Urológicas/genética
Biologia Molecular
-Biópsia
Neoplasias Urológicas/cirurgia
Gradação de Tumores
Procedimentos Cirúrgicos Robóticos
Limites: Humanos
Tipo de Publ: Editorial
Responsável: BR1.1 - BIREME


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Id: lil-785715
Autor: Barbosa Junior, Humberto do Nascimento; Siqueira Junior, Tiberio Moreno; Barreto, Françualdo; Menezes, Leonardo Gomes; Luna, Mauro José Catunda; Calado, Adriano Almeida.
Título: 4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results
Fonte: Int. braz. j. urol;42(3):438-448tab, graf.
Idioma: en.
Resumo: ABSTRACT Introduction There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer. Objective To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon. Patients and methods A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out. Results The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter. Conclusion The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity.
Descritores: Prostatectomia/métodos
Laparoscopia/métodos
Curva de Aprendizado
-Complicações Pós-Operatórias
Período Pós-Operatório
Prostatectomia/educação
Prostatectomia/estatística & dados numéricos
Neoplasias da Próstata/cirurgia
Neoplasias da Próstata/patologia
Fatores de Tempo
Brasil
Anastomose Cirúrgica
Estudos Retrospectivos
Resultado do Tratamento
Laparoscopia/educação
Laparoscopia/estatística & dados numéricos
Período Perioperatório
Gradação de Tumores
Duração da Cirurgia
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Idoso
Responsável: BR1.1 - BIREME



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