Radical Nephrectomy Research Articles

The prognostic value of visible hematuria is only significant in T1a renal cell carcinoma: a single-center retrospective study

ObjectivesTo investigate the prognostic value of visible hematuria in T1a renal cell carcinoma (RCC).Materials and methodsIn the RCC database of the Chinese People’s Liberation Army General Hospital Department of Urology, we assembled the records of patients with unilateral RCC over 18 years of age diagnosed between 2008 and 2019. The clinical stage was cT1, and the tumors ranged in size from 0 to 7 cm. The primary treatments were partial nephrectomy (PN) or radical nephrectomy (RN). Logistic regression analysis, Cox regression, interaction analysis, and Kaplan-Meier survival analysis were used to study the correlation between visible hematuria and progression-free survival (PFS), and cancer-specific survival (CSS).ResultsA total of 7,610 patients with cT1 RCC comprised the study population, including 505 RCC patients with visible hematuria. The average follow-up time was 64.6 months (range: 12–144 months). Visible hematuria was significantly associated with the prognosis (PFS, hazard ratio [HR] = 2.7, P < 0.001; CSS, HR = 4.2, P < 0.001) of T1a RCC, but was more significant for CSS in cases of a tumor size ≤ 2 cm (HR = 26.8, P = 0.026). This effect was not significant in T1b RCC (PFS, HR = 0.7, P = 0.153; CSS, HR = 1.1, P = 0.862). The interaction between visible hematuria and tumor size was significant (P = 0.001).ConclusionsThis study showed that visible hematuria was an independent risk factor for PFS and CSS in T1a RCC. The predictive value of visible hematuria for CSS was more significant in RCCs ≤ 2 cm, but did not reach statistical significance in T1b RCC. T1a RCC patients with visible hematuria should be intensively monitored during follow-up.

Small renal mass: which criteria are decisive for a tumor board?

Small renal masses (SRM) are aheterogeneous group of tumors with varying metastatic potential. The increasing use and improvement in the quality of abdominal imaging have led to an increasingly earlier diagnosis of incidental SRM, which are asymptomatic and confined to the organ. Despite these advances in imaging and the growing use of renal tumor biopsies, preoperative diagnosis of malignancy remains difficult. The treatment of SRM has shifted away from radical nephrectomy and now primarily includes organ-sparing surgery or active surveillance. The optimal strategy for treating SRM is continuously evolving as studies from prospective data registries can identify factors that influence both short- and long-term patient outcomes. Recent research on biomarkers, imaging techniques, and machine learning offer promising approaches to adeeper understanding of tumor biology and treatment options for this patient population.

Surgical and Oncological Outcomes of Level III-IV Versus Level I-II Inferior Vena Cava Thrombectomy: A Decennial Experience of a High-Volume European Referral Center.

In patients with renal cell carcinoma (RCC) the role of the extent of tumor thrombus into the inferior vena cava (IVC) has never been addressed from a surgical and oncologic standpoint. This study aims to evaluate differences between level III-IV versus level I-II patients concerning peri- and postoperative morbidity, additional treatments and long-term oncological outcomes. Overall, 40 patients with RCC underwent radical nephrectomy (RN) with IVC thrombectomy at a single European institution between 2010 and 2023. Complications were reported according to the European Union (EAU) guidelines recommendations. Spider chart served as graphical depiction of surgical and oncologic outcomes. Overall, 22 (55%) and 18 (45%) patients harbored level III-IV and I-II IVC thrombus. Level III-IV patients experienced significantly higher rates of intraoperative transfusions (68 vs 39%), but not significantly higher rates of intraoperative complications (32% vs 28%). Level III-IV patients had significantly higher rates of postoperative transfusions (82% vs 33%) and Clavien Dindo ≥3 complications (41% vs 15%). In level III-IV versus level I-II patients, median follow up was 482 and 1070 days, the rate of distant recurrence was 59% and 50%, the rate of systemic progression was 27% and 13%, and the rate of additional treatment/s was 64% and 61%, respectively (all p values > 0.05). Overall survival was 36% in level III-IV patients and 67% in level I-II (p = 0.001). Our findings suggest that patients with level III-IV RCC who are candidates for IVC thrombectomy should be counselled about the higher likelihood of postoperative severe adverse events and worse overall survival relative to level I-II counterparts.

P186 Outcomes of radical nephrectomy with vena cava thrombectomy in renal cell carcinoma: A decade-long retrospective analysis

P186 Outcomes of radical nephrectomy with vena cava thrombectomy in renal cell carcinoma: A decade-long retrospective analysis

P205 Comparative outcomes of partial vs. radical nephrectomy for localized renal carcinomas: Insights from real-world data

P205 Comparative outcomes of partial vs. radical nephrectomy for localized renal carcinomas: Insights from real-world data

Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Non-Metastatic Paediatric Wilms' Tumour Patients Undergoing Upfront Radical Nephrectomy.

To analyse the relationship between the preoperative systemic immune-inflammation index (SII) and the relapse-free survival (RFS) of paediatric patients with Wilms' tumour (WT) after radical surgery, and to establish and validate a prognostic survival model. Observational study. Place and Duration of the Study: Department of Oncologic Surgery, Anhui Children's Hospital of Fudan University, Hefei, China, from January 2013 to August 2023. A retrospective analysis was conducted on 79 WT patients treated with radical resection, with their preoperative SII values computed. The best cut-off for SII was determined through the ROC curve, categorising patients into high and low SII groups. The Kaplan-Meier method and Cox-regression were used for survival analysis. A survival prognostic model was constructed and its predictive capability gauged (AUC of the ROC). The study included 79 WT patients with a median RFS of 65 months and an average of 75.5 ± 3.4 months. The optimal cut-off value for SII was 534.95. The low SII group had a higher RFS (Log-rank: χ2 = 9.380, p = 0.002). Preoperative SII (HR = 3.277, 95% CI: 1.167 - 9.200, p = 0.024), clinical staging (HR = 8.408, 95% CI: 2.604 - 27.147, p <0.001), and tissue differentiation (HR = 2.237, 95% CI: 1.043 - 5.828, p = 0.039) were independent risk factors for RFS. The model's diagnostic performance was 0.749 (95% CI: 0.636 - 0.861). Internal validation showed an AUC of 0.723 (95% CI: 0.608 - 0.838). Lower preoperative SII suggests a more favourable prognosis. The SII-based nomogram efficiently forecasts post-radical surgery prognosis for WT. Wilms' Tumour, Systemic immune-inflammation index, Relapse-free survival, Nomogram.

Detection of Small Brain Metastases by 18F-Thretide PET/CT in Clear Cell Renal Cell Carcinoma.

A 46-year-old woman with a history of radical nephrectomy for clear cell renal cell carcinoma underwent 18F-FDG and 18F-Thretid (also known as Al18F-PSMA-BCH) PET/CT. Although the 18F-FDG PET/CT failed to detect any brain metastases, the 18F-Thretide PET/CT revealed 2 small metastases: one measuring 1.0 × 0.7 cm in the right cerebellum and the other measuring 0.4 cm in the right frontal lobe. These metastatic lesions were subsequently confirmed by brain MRI.

Treatment Modalities and Risks of Complication for Patients With Localized Renal Cell Carcinoma Aged 75 and Older.

Partial (PN)/radical (RN) nephrectomy is the standard treatment for localized renal-cell carcinoma (RCC). The potential risks of these procedures are concerns for the elderly. We evaluated perioperative outcomes/survival for patients aged ≥ 75 years with localized RCC who underwent PN, RN, or thermal ablation (TA). Localized RCC patients undergoing PN/RN/TA (2000-2023) were retrospectively reviewed. Logistic-regression assessed factors associated with major complications. Kaplan-Meier estimated survival. A total of 278 patients (≥ 75 years) with RCC who received intervention (107RN, 101PN, and 70TA) were identified. Median age was 78 years. PN patients were younger than other cohorts (77 vs. 79, p = 0.006). Patients with cancer comorbidities underwent TA than PN/RN (93% vs. 88%/76%, respectively). Median tumor size was 4.0, 3.0, and 2.6 cm in RN, PN, and TA cohorts, respectively. RN patients had more complex masses compared to other cohorts (9 vs. 7, p < 0.001). Postoperative complications were significantly greater among PN patients (p = 0.03), but there was no significant difference in Clavien ≥ 3 complications. Peripheral vascular disease (PVD) was associated with Clavien ≥ 3 complications on multivariable analysis (p = 0.03). RN was performed at a stable rate while PN decreased in favor of TA. There was no significant difference in RCC-/non-RCC-specific survival among treatment modalities. It is important to make informed decisions about treating RCC in the elderly to reduce morbidity/mortality. PVD could be a determining factor favoring TA for amenable tumors.

Survival improvement over time in renal cell carcinoma treated with nephrectomy: A longitudinal propensity score-matched study.

Surgical treatment for renal cell carcinoma (RCC) has drastically evolved for the past 30 years. However, survival outcomes of RCC according to times have not been fully elucidated, especially in the real-world setting. This study aimed to assess the survival improvement over time in RCC treated with nephrectomy by analyzing a longitudinal cohort using propensity score matching (PSM). We retrospectively reviewed 960 patients with RCC who underwent radical or partial nephrectomy between 1981 and 2018. Patients were divided into two groups according to the time of surgery (1981-1999 vs. 2000-2018). Using PSM, overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were compared between the two groups. Overall, 255 and 705 patients underwent surgery in the earlier (1981-1999) and recent (2000-2018) eras, and PSM derived a matched cohort of 466 patients (233 patients per each group). All patients in the earlier era cohort received open surgeries, whereas about a half (47.4%) of patients in the recent era cohort received minimally-invasive (laparoscopic/robotic) surgeries. After PSM, 137 (29.4%) patients developed recurrence, 105 (22.5%) died of RCC, and 113 (24.2%) died from other causes, with a median follow-up period of 90 months. The recent era cohort had significantly longer OS, CSS, and RFS than the earlier era cohort. Patients with RCC treated in the recent era (2000-2018) showed significantly longer survival than those treated in the earlier era (1981-1999). The improved survival might be attributable to the prevalence of minimally-invasive (laparoscopic/robotic) surgeries.

Clinical characteristics of renal anastomotic hemangioma.

In this editorial, we comment on the article by Chen and Cai. We focus on renal anastomotic hemangioma, which is a rare benign hemangiomatous disease. This disease has unique clinical characteristics. Its biological behavior is benign, but its imaging results are similar to those of renal cancer. Renal anastomotic hemangioma is easy to misdiagnose and can lead to unnecessary radical nephrectomy. Therefore, urologists need a better understanding of this disease. We believe that patients with renal anastomotic hemangioma should receive individualized diagnosis and treatment to avoid overtreatment.

A Randomized Controlled Trial Assessing the Release of Circulating Tumor and Mesenchymal Cells in No-Touch Radical Nephrectomy

Background: Circulating tumor cells (CTCs) may be the missing renal cell carcinoma (RCC) biomarker. No-touch (NT) resection has shown benefit in several tumors. Methods: A randomized controlled trial comparing CTC and circulating mesenchymal cell (CMC) release in no-touch (NT) vs. conventional (C) laparoscopic RN. Blood samples were collected at operation room arrival (S0), specimen extraction (S1), postoperative D1, and D30. CTCs were isolated and analyzed using RUBYchip™. Results: Thirty-four patients were included. No significant differences were found between groups in CTC and CMC counts, count variations between time points, complications, and survival. The total circulating cell detection rates in the NT, C, and overall RCC groups were 58.3%, 80.0%, and 70.4% at S0; 41.6%, 86.7%, and 66.7% at S1; 50.0%, 64.3%, and 60.0% at D1; and 54.5%, 42.9%, and 44.0% at D30, respectively. A progressive decrease in CMCs was observed in the C group after surgery, especially at D1 (4.78 to 1.64 CMCs/7.5 mL blood, p = 0.035). Healthy controls had no circulating cells; however, high CMC counts were found in chronic inflammation controls and oncocytoma patients, with no significant difference from RCC patients (p = 0.460). Conclusions: NT RN did not reduce circulating cell release nor improve survival compared to C RN.

Meta-analysis and systematic review of factors predicting conversion to radical nephrectomy following robotic-assisted partial nephrectomy in renal cancer patients.

Evaluating the risk factors for the conversion from robotic-assisted partial nephrectomy (RAPN) to radical nephrectomy (RN). Through a comprehensive database search encompassing PubMed, Web of Science, Embase, and the Cochrane Library, we identified pertinent English-language research published by June 2024. We utilized the NOS scale for quality assessment. The aggregate effect was quantified via the odds ratio (OR), alongside a 95% confidence interval (CI). Sensitivity analyses were conducted using both fixed-effects and random-effects models to evaluate reliability. The meta-analytical process was facilitated by the Stata 18 software suite. Our meta-analysis encompassed a total of 8 retrospective studies and 3 prospective studies, totaling 4056 patients. We found that increasing patient age (OR: 1.04; 95% CI 1.00-1.08; P = 0.005), higher American Society of Anesthesiologists (ASA) scores (3 or above) (OR: 2.74; 95% CI 1.52-4.93; P = 0.001), elevated R.E.N.A.L. scores (7 or above) (OR: 2.49; 95% CI 1.57-3.95; P < 0.001), and the use of off-clamp RAPN (OR: 7.21; 95% CI 2.60-19.93; P < 0.001) significantly raised the odds of surgical conversion. On the other hand, male sex (OR: 1.04; 95% CI 0.67-1.62; P = 0.858), the side of the tumor (OR: 0.97; 95% CI 0.48-1.95; P = 0.936), tumor size (OR: 3.43; 95% CI 0.57-20.55; P = 0.177), body mass index (BMI) (OR: 1.03; 95% CI 0.96-1.11; P = 0.426), clinical stage (OR: 3.78; 95% CI 0.46-30.70; P = 0.214), and the use of single-port RAPN (OR: 0.54; 95% CI 0.16-1.78; P = 0.31) did not show a statistically significant link to an increased conversion risk. This meta-analysis elucidates the critical risk factors for the conversion from robotic-assisted partial nephrectomy to radical nephrectomy, providing significant guidance for preoperative risk assessment and clinical decision-making. However, our findings necessitate validation through studies with larger sample sizes.

Open versus mini-invasive partial and radical nephrectomy complications: results from the French national health database

BackgroundLaparoscopic surgery is associated with a lower morbidity than open surgery. No recent data compared kidney cancer surgery in the French population using the National Health Insurance database (PMSI-MCO).AimsWe explore and compare the surgical morbidity rates between laparoscopic and open laparotomy for kidney cancer.MethodsThe initial length of stay and complications parameters during the three postoperative months were described for renal cancer in every French center in 2018. We compared Relative Risks (RR [95% CI]) between laparoscopic and open surgery for both radical and partial nephrectomy.ResultsAmong 8,162 patients, 3,525 had a radical nephrectomy, 978 open, 2,547 laparoscopic surgeries; 4,637 patients had partial nephrectomies, 1,778 open 2,859 laparoscopic surgeries. For radical surgery, the most common complications were urinary infections (7.8%), acute renal failure (8.9%), sepsis (8.4%), bleeding (9.3%), and postoperative anemia (5.9%); the RR for laparoscopic versus open surgery were respectively 0.68 [0.54;0.86], 0.71 [0.57;0.88], 0.69 [0.55;0.86], 0.83 [0.66;1.03], 0.56 [0.43;0.73]. For partial nephrectomies, the most common complications were urinary infections (7.7%), bleeding (11.6%), and postoperative anemia (5.8%), with RR of 0.71 [0.58;0.87], 0.61 [0.52;0.71], and 0.64 [0.51;0.81]. The mean length of stay was 7.7 for open radical nephrectomy, 6.3 for laparoscopic radical nephrectomy, 7.5 for open partial nephrectomy, and 5 for laparoscopic partial nephrectomy.ConclusionsThe laparoscopic approach had fewer postoperative complications and a shorter length of stay than open surgery for partial and radical nephrectomy. The PMSI analysis provided an exhaustive description of surgical practice for kidney cancer and surgical complications in France.Clinical trial numberNot applicable.

Renal Cell Carcinoma with Venous Tumor Thrombus: 15 Years of Experience in an Oncology Center.

Background: The purpose of this study is to report the experience of a single Portuguese oncology center in the management of patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT). Methods: This is a retrospective analysis of all patients with RCC and VTT surgically treated in our center between 2008 and 2023. Only patients with VTT up to level III (Mayo Clinic classification) were included. Patient, tumor characteristics and peri-operative outcome data were registered. Administration of systemic therapy was performed upon progression. Survival analysis was conducted with the collected data. Results: A total of 64 patients (n = 16 women) were included in this study. The mean age at diagnosis was 66.3 ± 10.7 years old. The VTT level was 0, I, II and III in 40 (62.5%), 12 (18.7%), 6 (9.4%) and 6 (9.4%) patients, respectively. Nine patients (14.1%) had distant metastasis at diagnosis. No peri-operative deaths occurred, and the major complication rate was 3.1%. Histology revealed 98.4% of clear cell RCC, with sarcomatoid differentiation present in 12.5% of the cases. A negative margin status was achieved in 54 (84.4%) patients. Systemic therapy was administered in 24 (37.5%) patients during follow-up. The median progression-free (PFS), cancer-specific (CSS) and overall (OS) survival were 23, 60 and 48 months, respectively. In multivariable analysis, significant predictors of CSS were tumor size, sarcomatoid differentiation and collecting system invasion. Conclusions: Radical nephrectomy with VTT excision up to level III is a feasible and safe procedure. Patients with large tumor size, sarcomatoid differentiation and collecting system invasion are at the highest risk and should be closely monitored.

Complications of Tumor Nephrectomy with and Without Tumor Thrombus in the Vena Cava, Recorded with the Clavien–Dindo Classification: A Matched-Pair Analysis

Background/Objectives: Radical nephrectomy (RN) with inferior vena cava thrombectomy (IVCT) is indicated for the curative management of renal cell carcinoma (RCC) with tumor thrombus (TT). In the literature, any direct comparison of complications between RNs with or without IVCT is lacking. The objective of this study was to analyze and compare complications after RNs with or without IVCT. Methods: A retrospective evaluation of the complications recorded in RCC patients who underwent RN with (TT group, n = 44) or without (non-TT group, n = 44) IVCT between 2009 and 2021 was conducted. The non-TT group was identified via propensity-score matched-pair analysis. Postoperative complications up until discharge or postoperative day 30, whichever came first, were classified using the Clavien–Dindo classification (CDC). Complications were categorized into cardiovascular, pulmonary, bleeding, gastrointestinal, neurological/psychiatric, wound, urinary tract, dysglycemia, and other groups. Statistical analyses using descriptive statistics included the chi2 and Mann–Whitney U tests. Results: All CDC-grade postoperative complications were more frequent in the TT than in the non-TT group regarding the number of patients affected (93% vs. 73%), as well as per patient (median: 3 vs. 1; p &lt; 0.001). Complications in CDC grade ≥ 3 were rare and comparable between groups. Cardiovascular, gastrointestinal, neurological/psychiatric, and bleeding complications occurred significantly more often in the TT group. However, its small study population and retrospective character limit this study. Conclusions: Significantly more patients undergoing an RN-IVCT experience more frequent postoperative complications than patients with an RN but without IVCT. Surgeons performing the procedures should be experienced, and hospital staff should be trained in the early recognition and treatment of complications.

Pathological Insights into Non-Neoplastic Renal Parenchyma in Wilms Tumor: Implications for Nephron-Sparing Surgery.

This study aimed to evaluate the non-neoplastic renal parenchyma in Wilms tumor (WT) and investigate its impact on nephron-sparing surgery (NSS). The non-neoplastic renal parenchyma of WT patients was prospectively collected for pathological examination. The histology of non-neoplastic renal parenchyma was assessed from two perspectives: nephrogenic rests (NRs) and nephrons. A total of 46 non-neoplastic renal parenchyma specimens were collected from 42 WT patients. The surgeons assessed the median proportion of non-neoplastic renal parenchyma as 30%, whereas using ellipsoid volume, it was calculated to be 27%. The Youden index of surgeons' assessment peaked at a 15% proportion of non-neoplastic renal parenchyma. The bilateral WT (BWT) group and NSS group exhibited significant differences compared with the unilateral WT group and radical nephrectomy group, respectively, with the BWT group showing a tendency toward thickened basement membrane. The presence of NRs and endogenous nephron alternations should be given due attention in WT. The probability of abnormalities is low when the proportion of non-neoplastic renal parenchyma exceeds 15%, providing pathological support for expanding the adaptation of NSS.

The Added Value of Controlling Nutritional Status (Conut) Score for Preoperative Counselling on Significant Early Loss of Renal Function After Radical Nephrectomy for Renal Cell Carcinoma

Background and Objectives: We aimed at evaluating the impact of Controlling Nutritional Status (CONUT) score on clinically significant decline in estimated glomerular filtration rate (eGFR) in patients with non-metastatic Clear Cell Renal Cell Carcinoma (ccRCC) undergoing radical nephrectomy (RN). Materials and methods: We retrospectively analyzed a multi-institutional cohort of 140 patients with ccRCC who underwent RN between 2016 and 2018 at three Urological Centers. The CONUT score was calculated with an algorithm including serum albumin, total lymphocyte count, and cholesterol. Clinical and pathologic features were analyzed using Fisher’s exact test for categorical variables and a Mann–Whitney U test for continuous variables. To define the independent predictors of clinically significant eGFR decline, univariable (UVA) and multivariable (MVA) binomial logistic regression analyses were performed in order to assess the Odds Ratio (OR) with 95% Confidence Intervals (CIs). Results: The optimal cut-off value to discriminate between a low and high CONUT score was assessed by calculating the ROC curve. The area under the curve (AUC) was 0.67 (95%CI 0.59–0.78) with the most appropriate cut-off value at 2 points. Overall, 46 patients (32.9%) had a high CONUT score (&gt;2). Statistically significant variables associated with eGFR decline at 24 months were age ≥ 70 (OR 2.01; 95%CI 1.17–3.09; p 0.05), stage II–III chronic kidney disease (CKD) (OR 6.05; 95%CI 1.79–28.3; p 0.001), and a high CONUT score (OR 3.98; 95%CI 1.58–10.4; p 0.004). Conclusions: The CONUT score is a low-time-consuming, cost-effective, and promising tool able to preoperatively screen patients at risk of developing CKD after a RN.

18F-FDG PET/CT Findings of Isolated Renal Metastasis From Squamous Cell Lung Cancer.

We present the 18F-FDG PET/CT findings of a 64-year-old man with isolated renal metastasis. He had a history of radical surgery for squamous cell lung cancer 14 months ago, followed by chemotherapy and immunotherapy. The renal metastasis presented as a small focus of increased FDG uptake in the restaging 18F-FDG PET/CT scan, which was regarded as renal cortical tracer retention. The renal metastasis was more prominent on the second PET/CT performed 5 months later. The patient subsequently underwent radical nephrectomy, and histopathological examination confirmed the diagnosis of renal squamous cell carcinoma metastasis.

Clinical application and efficacy analysis of robot-assisted laparoscopic tumor enucleation combined with tumor aspiration in the treatment of renal hilar angiomyolipoma

BackgroundFor renal hilar angiomyolipoma, general surgical resection is often quite challenging. The aim of this study is to evaluate the safety and efficacy of an innovative robot-assisted laparoscopic strategy that combines tumor enucleation with tumor aspiration in the treatment of renal hilar angiomyolipoma.MethodsThe clinical data of 38 patients with renal hilar angiomyolipoma who went through robotic tumor enucleation combined with tumor aspiration in the Department of Urology, the Affiliated Hospital of Nanjing University Medical School, from December 2019 to December 2022 were retrospectively analyzed. The basic characteristics, the perioperative variables, intraoperative procedures, and postoperative complications were all recorded. Patients were followed up to evaluate the angiomyolipoma recurrence and the renal function by urologic CT or ultrasound and renal function tests.ResultsAll surgeries were successfully completed without conversion to radical nephrectomy or open surgery. One patient developed urinary extravasation 10 days after surgery, and was readmitted to the hospital for transurethral ureteral stenting considering the injury of the renal collecting system. The median operative time was 181.5 (123.8-206.3) min, the warm ischemia time was 20.0 (17.3–24.0) min, the blood loss was 125 (100.0-262.5) ml, and no patients received blood transfusion during and after surgery. The median hospitalization time was 7.0 (6.0–9.0) days, and the duration of indwelling drainage tube was 2.0 (2.0–3.0) days. The serum creatinine (Scr) on the first day, 3 months, and 6 months after surgery were 55.5 (50.8–62.8) µmol/L, 55.5 (48.0–62.0) µmol/L and 54.0 (51.8–63.5) µmol/L, respectively, and there was no significant difference compared with the preoperative level 56.0 (47.8–60.3) µmol/L. All patients were followed up after surgery, and the urinary CT scan or renal color doppler ultrasound, and renal function were reexamined. The median follow-up time of all patients was 19.0 (14.75-33.0) months, and no local recurrence of angiomyolipoma was seen in all patients.ConclusionsThe surgical strategy of robot-assisted laparoscopic tumor enucleation combined with tumor aspiration is safe and effective in the treatment of renal hilar angiomyolipoma.

Stenosis of the glomerulotubular neck in progressive chronic kidney disease.

Morphology and morphometric evaluation of lesions beyond conventional parameters can inform the pathophysiology of chronic kidney disease (CKD). We sought to determine whether the occurrence of glomerulotubular neck stenoses associates with progressive CKD. We evaluated the normal parenchyma from radical nephrectomies removed for tumor between 2000 and 2021 and analyzed cortex for stenoses of the glomerulotubular neck. Stenosis of the glomerulotubular neck is defined a focal narrowing for which the draining tubule has a greater diameter than at the neck. Progressive CKD was defined as dialysis, kidney transplantation, sustained eGFR <10 ml/min per 1.73m2 or sustained 40% decline from the post-nephrectomy eGFR. Each case of progressive CKD was age-sex-matched to 2 controls without progressive CKD. Logistic regression models assessed the risk of progressive CKD with stenotic necks adjusting for other histological features, kidney function, and CKD risk factors. There were 65 cases with a mean of 255 glomeruli and 130 controls with a mean of 329 glomeruli. Among both cases and controls, 5% of glomeruli showed visible glomerulotubular necks. The proportion of necks that were stenotic was higher in cases than controls (35% vs. 11%, p<0.0001). Stenotic necks associated with progressive CKD independent of other histologic and clinical characteristics. Glomerulotubular neck stenosis is associated with development of progressive CKD.