Patients Undergoing Radical Nephrectomy Research Articles

Incidental Succinate Dehydrogenase (SDH) Deficient Renal Cell Carcinoma and Paraganglioma in a 24-Year-Old

Abstract Introduction/Objective Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) is rare neoplasm (<0.2% of all RCCs) caused by SDH-subunit gene mutation, usually SDHB. Patients carrying such mutations are also predisposed to other SDH-deficient neoplasms such as paraganglioma, gastrointestinal stromal tumor, and pituitary adenoma. Here, we report a case of incidental SDH-deficient RCC and paraganglioma. Methods/Case Report A 24-year-old male without past medical or family history presented to ED for perianal abscess. Imaging showed 8-cm heterogeneous left renal mass (figure-A) and 3.3-cm mass below aortic bifurcation, highly concerning for RCC with metastasis. Biopsy of kidney mass showed nested and trabecular epithelial neoplasm with weakly eosinophilic and occasionally vacuolated cytoplasm (figure-B). Nuclei were round with smooth contour and inconspicuous nucleoli. Tumor was immunopositive for PAX8, e-cadherin, P504S, and CD10, while negative for CK7, CD117, and Melan-A. SDHB immunostain was negative in tumor with intact staining in intervening endothelium. Findings were consistent with SDH-deficient RCC. Biopsy of pelvic mass showed low-grade neoplasm that was immunopositive for synaptophysin, chromogranin, and GATA3, with S100-positive sustentacular cells, consistent with paraganglioma. Patient underwent radical nephrectomy which revealed 7.5-cm, well-circumscribed, tan-red, predominantly solid mass with few cysts. Histologically, tumor had thin fibrous capsule and morphologically similar to biopsy. Tumor was limited to kidney without necrosis, sarcomatoid/rhabdoid differentiation, or vascular invasion. Results (if a Case Study enter NA) NA. Conclusion SDH-deficient RCC is rare low-grade entity with risk of metastasis and development of other neoplasms, which requires continued follow-up and potential genetic testing for patient and family members. Therefore, including SDH-deficient RCC in differential diagnosis of eosinophilic renal neoplasms is essential.

Sarcomatoid Chromophobe Renal Cell Carcinoma with Heterologous Elements: A Rare Form of an Aggressive Tumor

Abstract Introduction/Objective Chromophore renal cell carcinoma (ChRCC) accounts for approximately 4-10% of renal cell carcinomas. Compared with other subtypes of renal cell carcinoma, ChRCC generally has a more favorable outcome; however, sarcomatoid transformation is greatest in ChRCC. We report a case of ChRCC with extensive sarcomatoid transformation, which included the heterologous elements of osteosarcoma and chondrosarcoma. The presence of heterologous elements is distinctively rare, with only twelve previous cases in the English literature. Methods/Case Report A 64-year-old man presented with left flank pain and night sweats. The abdominal MRI showed a large exophytic hypervascular mass in the left kidney with metastasis to the left para-aortic lymph nodes. The patient underwent radical nephrectomy. Two months after the surgery, the patient was found to have extensive bony metastases. On gross examination, the nephrectomy specimen showed an 18 cm tumor replacing almost the entire kidney. The cut surface was white to tan with areas of hemorrhage and necrosis. Microscopic examination revealed a predominantly sarcomatoid ChRCC (nearly 80% of the tumor) with heterologous chondrosarcoma and osteosarcoma. The tumor extended into the perinephric adipose tissue and the adrenal gland. Multiple para-aortic lymph nodes contained sarcomatoid tumor with heterologous elements. Results (if a Case Study enter NA) NA. Conclusion ChRCC is frequently considered a more indolent renal cell carcinoma. It is important to recognize its higher propensity for sarcomatoid transformation. The presence of heterologous elements is exceptionally uncommon. Whether this correlates with a more aggressive tumor is not known because of the paucity of such cases.

The incidence and risk factors of chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma

BackgroundRadical nephrectomy (RN) is the standard treatment for localized renal cell carcinoma. The decrease in nephrons from RN could lead to postoperative chronic kidney disease (CKD). In this study, we aim to investigate the incidence and risk factors for CKD in patients who have received RN.MethodsA Total of 1233 patients underwent radical nephrectomy in Zhejiang Provincial People’s Hospital from January 2010 to December 2018. Those who had an abnormal renal function before surgery or were lost to follow-up were excluded. Five hundred patients were enrolled in the end. eGFR was calculated using the abbreviated MDRD equation. CKD was defined as eGFR less than 60 ml/min/1.73m2. The incidence of postoperative CKD was estimated using the Kaplan-Meier method. The independent risk factors for CKD occurrence were determined through logistic multivariate regression analysis.ResultsPatients were followed up for a median of 40 month (3–96 months), with CKD occurring in 189 cases. The 5-year cumulative incidence of CKD was 43.4%. There was a significant difference between these189 patients and the remaining patients without post nephrectomy CKD in terms of age, sex, weight, and preoperative eGFR(P<0.05). Multivariate regression analysis showed that age (OR = 1.038, 95%CI = 1.002–1.076), preoperative eGFR of the contralateral kidney (OR = 0.934, 95%CI = 0.884–0.988) and Immediate postoperative eGFR (OR = 0.892, 95%CI = 0.854–0.931) were independent risk factors for postoperative CKD.ConclusionsThe incidence of CKD after radical nephrectomy was not uncommon. Age, preoperative eGFR of the contralateral kidney and Immediate postoperative eGFR are independent risk factors for postoperative CKD.

Appendiceal neuroendocrine tumour association in a patient with a large sarcomatoid renal cell carcinoma

Renal cell carcinoma (RCC) can develop into sarcomatoid differentiation which demonstrates aggressive biological behavior evident by the rapid progression of the tumour with multiple metastases. Though the appendiceal neuroendocrine tumour (NET) has a good prognosis, the prognosis can be worse when associated with the sarcomatoid RCC (sRCC). A 45-year-old female patient presented to the emergency department with a 2-month history of worsening right upper abdominal pain, nausea, vomiting, and significant weight loss. Computed tomography (CT) revealed heterogeneously enhancing solid cystic mass lesions arising from a lower pole of the right kidney with a tumour thrombus involving the entire right renal vein and extending into the inferior vena cava (IVC). The patient underwent radical nephrectomy and appendectomy and was managed conservatively due to the poor prognosis. After four weeks, she presented with severe right upper abdominal pain, and Magnetic resonance imaging (MRI) indicated a possible liver metastasis and tumour necrosis. In three weeks, the patient died of respiratory failure following multiple organ dysfunction syndrome (MODS). This case report outlines a presentation of sRCC with biologically aggressive disease progression and a rare association with appendiceal NET. CT, MRI, and PET scans can be helpful in the diagnosis and monitoring of disease progression. Early identification of the sRCC and appendiceal NET will contribute to better outcomes of the disease and complications. The prognostic elements and similar genetic patterns of sRCC and appendiceal NET would be of great clinical interest.

Outcome and surgical management of symptomatic renal angiomyolipoma in Ibadan, Nigeria, Sub-Saharan Africa.

Renal angiomyolipoma is the commonest benign solid kidney neoplasm though rare in clinical practice. The advent of radiological imaging techniques, refinement in surgical approach and techniques and availability of mammalian target of rapamycin have improved the outcome in these cohort of patients. To report our experience with the surgical management of renal angiomyolipoma in the sub-Saharan Africa. This was a retrospective review of the records in the operating theatre book of urology division of patients who underwent radical nephrectomy over a 7-year-period (January 2013 to December 2019). The histologically confirmed renal angiomyolipoma information were retrieved from the records in the Department of Pathology. The clinical data were obtained from the patients' case files by identifying the patient with their registration number and not their names. The clinical features, investigations done, treatment offered, and the outcome of management were recorded in an SPSS version 20. The data was analyzed using statistics of central tendency and percentage. Only 3 females with symptomatic renal angiomyolipoma were managed. This represented 4.9% of 61 patients with solid renal masses managed in the study period. The mean age was 51.2 (ranged 40-70) years. The mean tumor size was 18.9 cm. All the patients underwent radical nephrectomy. The pre- and postoperative urea and creatinine remained normal. The median follow-up period was 21 (16.5-30) months and were asymptomatic. The incidence of renal angiomyolipoma among solid renal masses is 4.9% in our environment. Open radical nephrectomy is still the preferred method of treatment with satisfactory outcome.

Renal squamous cell carcinoma: A case report

: Primary squamous cell carcinoma of kidney is very rare finding and is rarely reported in literature. The disease is very aggressive in nature and carries poor prognosis with 5yr survival rate of <10%. We report here a case of 48yr old female who presented with complaints of pain in left side of abdomen, intermittent fever and was diagnosed with squamous cell carcinoma of kidney. The patient underwent radical nephrectomy.

Gallbladder metastasis from primary renal malignancy: case report and review

Gallbladder metastases are rare, that too from a renal malignancy are further rare. Renal cell carcinoma (RCC) accounts for 3% of adult malignancies and &gt;30% of cases are already metastatic by the time of presentation. Neither gallbladder is a usual site for RCC to metastasize nor is clear cell RCC common in gallbladder secondaries. We report one such case of a 50-year-old man who was incidentally diagnosed to have left sided renal cell carcinoma and developed gallbladder and lung metastases detected in follow-up imaging. Patient underwent radical nephrectomy followed by extended cholecystectomy later on. And presently is receiving targeted therapy for pulmonary metastases.

Eosinophilic solid and cystic renal cell carcinoma: a single Indian tertiary center experience of three cases of a newly described entity

BackgroundAmong adult malignant tumors, renal cell carcinoma accounts for 2–3% and has the worst prognosis among common urologic tumors. Recently, an eosinophilic, solid and cystic (ESC) renal cell carcinoma (RCC) histological subtype has been described and proposed as an entity separate than the 16 subtypes described in the 2016 WHO classification. The aim of the present study is to share our experience of three such cases of this newly described entity.MethodsWe retrospectively reviewed our cases of renal cell carcinoma and describe the presentation, diagnosis and management with follow-up details of ESC RCC.ResultsOur three patients presented at an advanced stage with flank pain or mass, and one patient had metastasis. All patients underwent radical nephrectomy, diagnosis proved by histopathological examination with immunohistochemistry (IHC), with abundant eosinophilic cytoplasm in all three cases. On IHC, CK 20 was positive in two cases and one patient with CK 20, CK 7 negative and PAX 8 positive.ConclusionsESC RCC is a newly described entity, with increasing incidence probably due to better diagnosis. Previously, 66 such cases are described, with female predominance, lower stage and indolent behavior. Only four cases with metastasis are described.

Histological features suggestive of survival in patients with renal cell carcinoma and tumor thrombus: A single-center experience.

PurposeTo evaluate the impact of histological subtype on the survival of patients with renal cell carcinoma (RCC) and tumor thrombus (TT).Patients and methodsWe retrospectively analyzed 350 patients with RCC and TT admitted to Chinese People’s Liberation Army General Hospital between January 2006 and June 2021. The patients underwent radical nephrectomy and thrombectomy using robot-assisted laparoscopic, laparoscopic, or open surgery. The clinical and pathological parameters of the patients were taken from their medical records. Survival was calculated with the Kaplan–Meier method. Univariate and multivariate Cox regression analyses were performed to evaluate the prognostic significance of variables on overall survival (OS) and progression-free survival (PFS).ResultsTT levels 0–IV were observed in 132 (37.71%), 43 (12.29%), 134 (38.29%), 20 (5.71) and 21 (6.00%) patients, respectively. Papillary (pRCC), clear cell, and other histological subtypes of RCC were detected in 28 (8.00%), 286 (81.71%), and 36 (10.29%) patients, respectively. Compared to the clear cell cohort, collecting systemic invasion (46.43 vs. 25.17%; p = 0.030) and lymph node metastasis (39.29 vs. 11.54%; p < 0.01) were more common in the pRCC cohort. Kaplan–Meier analyses showed that patients with pRCC and other subtypes had significantly worse OS and PFS compared to patients with the clear cell subtype (p < 0.05). Multivariate analyses revealed that histology was independently associated with reduced OS and PFS, including among patients without lymph node and distant metastasis (N0M0).ConclusionPapillary or other subtypes have a considerably shorter OS and PFS compared to clear cell subtype in RCC patients with TT. Strict follow-up and surveillance should be performed for papillary or other subtypes RCC with TT.

Retrospective Comparison of Clinical and Economic Outcomes of Non-Donor Patients Undergoing Radical Nephrectomy Using One of Two Different Linear Stapler Technologies for Transection of the Renal Vessels: Fixed-Height Gripping Surface Reloads vs Variable-Height Reloads.

PurposeTo compare outcomes of non-donor patients undergoing radical nephrectomy using fixed-height gripping surface (FHGS) vs variable-height Tri-Staple™ (VHTS) reloads for transection of the renal vessels.Patients and MethodsUsing the Premier Healthcare Database of US hospital discharge records, we selected non-donor patients undergoing inpatient radical nephrectomy with dates of admission between 1 October 2015, and 31 December 2020 (first=index admission). The primary outcome was in-hospital hemostasis-related complications (hemorrhage, acute posthemorrhagic anemia, and/or procedure to control bleeding) during the index admission. Secondary outcomes included index admission intraoperative injury, blood transfusion, conversion from minimally invasive to open surgery, total hospital costs, length of stay (LOS), discharge status, and mortality as well as 30-day all-cause inpatient readmission. We used stable balancing weights to balance the FHGS and VHTS groups on numerous patient, procedure, and hospital/provider characteristics, allowing a maximum post-weighting standardized mean difference ≤0.01 for all covariates; we also exactly matched the groups on laterality (right vs left kidney) and intended surgical approach (open, laparoscopic, robotic). We used bivariate multilevel mixed-effects generalized linear models accounting for hospital-level clustering to compare the study outcomes between the FHGS and VHTS groups.ResultsAfter weighting, the FHGS and VHTS groups comprised 2952 and 795 patients, respectively. The observed incidence proportion of the primary outcome of hemostasis-related complications during the index admission was similar between the groups (8.6% for FHGS vs 9.0% for VHTS, difference 0.4% [95% CI −3.2% to 2.5%], P=0.808). Differences between the FHGS and VHTS groups were not statistically significant for any of the secondary outcomes.ConclusionEndoscopic surgical staplers have become common for transection of the renal vessels during radical nephrectomy, with FHGS and VHTS being the predominant reload types. In this retrospective study of 3747 non-donor patients undergoing radical nephrectomy, use of FHGS vs VHTS reloads was associated with similar clinical and economic outcomes.

Diagnosis and treatment strategies for intraoperative pulmonary embolism caused by renal tumor thrombus shedding

To provide an overview of techniques for prevention, immediate diagnosis, and treatment strategies of intraoperative pulmonary embolism caused by renal tumor thrombus shedding. A total of 290 patients admitted into our medical center from March 2015 to May 2021 were retrospectively analyzed. All patients underwent radical nephrectomy with tumor thrombectomy. Six patients were diagnosed as pulmonary embolism during the perioperative period, of which two patients had tumor thrombus shedding. One patient underwent thoracotomy and thrombectomy, one patient underwent interventional thrombectomy, and four patients underwent conservative treatment. All patients have gone through our diagnosis and strategy flow chart. Demographic data, tumor characteristics, tumor thrombus characteristics, and follow-up data were collected. In the preoperative risk factor assessment, of the 253 patients who entered the follow-up, 163 were women, 48 were older than 60 years old, and 83 had a duration of more than 2 months. In addition, 27 patients had tumor thrombus with bland thrombus, and 43 patients had floating tumor thrombus. 78 patients underwent postoperative anticoagulation after evaluation. The average follow-up time was 23.3 8.6 months (range, 7-31 months). All patients were alive during the follow-up period. For acute pulmonary embolism during nephrectomy and tumor thrombectomy, management strategies can be used to deal with intraoperative emergencies and provide reference.

Primary Renal Well-Differentiated Neuroendocrine Tumors: Analyis of Six Cases from a Tertiary Care Center in North India with Review of Literature.

Well-differentiated renal neuroendocrine tumors are rare tumors. As their biologic behavior is not fully known, there is a need to know more about these cases. We performed a retrospective chart review of all the cases diagnosed with renal neuroendocrine tumors from January 2016 to December 2020 (five years) in order to understand their clinical features, morphological characteristics and outcome. We included six cases with mean age of 46.2 years (4 males) in our study. All patients underwent radical nephrectomy. Histologically all showed tumor disposed in nests and trabeculae and majority of the tumors belonged to well-differentiated neuroendocrine tumor Grade 1 (WHO criteria of gastoroenteropancreatic neuroendocrine neoplasms). Lymph node metastasis was seen in two cases at the time of clinical presentation. All the tumors were diffusely positive for neuroendocrine tumor markers (synaptophysin, chromogranin, NSE, CD56). Follow-up data was available in all cases with an average follow-up of two years and neither has shown evidence of metastasis or relapse till last follow-up. Role of morphological patterns and immunohistochemical markers is highlighted with the importance of including Ki-67 index in grading them to better understand their outcome.

Cancer du rein de l’adulte au Centre Hospitalo-universitaire de Tengandogo : Aspects épidémiologiques, cliniques, histopathologies et thérapeutiques

OBJECTIVE: To study the epidemiological, clinical and histopathological aspects of renal cancers at the University Hospital of Tengandogo. MATERIALS AND METHODS: There were a cross-sectional, descriptive and analytical study with retrospective collection over a period of 5 years and 6 months, from January 1st, 2016 to June 30, 2021. RESULTS: We treated 39 patients, 33 patients were included, with an exhaustiveness of 84.6%. The mean age of the patients was 52.6 years ± 11.7. The sex-ratio was 1.06. Eight patients had risk factors. Lumbar pain and hematuria were the most frequent circumstances of discovery. The average consultation time was 8.6 months ± 1.1. The physical examination had objectified a lumbar mass in 17 patients, 9 patients had lumbar contact and the examination was normal in 13 patients. The right kidney was the most affected side with 17 patients. The mean size of the tumor was 12.2 cm ± 2.4. All patients underwent radical nephrectomy. We recorded one death intraoperatively. The histological type was clear cell renal carcinoma in 32 patients. One patient had chromophobe cell renal cell carcinoma. CONCLUSION: Kidney cancer is a rare pathology, it occurs in adults around the age of fifty. Patients consult late and locally advanced and metastasized forms are the most frequent. The histological type is dominated by clear cell renal carcinoma. KEYWORDS: Cancer; Kidney; Nephrectomy.

Two-dimensional correlated spectroscopy distinguishes clear cell renal cell carcinoma from other kidney neoplasms and non-cancer kidney.

BackgroundRoutinely used clinical scanners, such as computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US), are unable to distinguish between aggressive and indolent tumor subtypes in masses localized to the kidney, often leading to surgical overtreatment. The results of the current investigation demonstrate that chemical differences, detected in human kidney biopsies using two-dimensional COrrelated SpectroscopY (2D L-COSY) and evaluated using multivariate statistical analysis, can distinguish these subtypes.MethodsOne hundred and twenty-six biopsy samples from patients with a confirmed enhancing kidney mass on abdominal imaging were analyzed as part of the training set. A further forty-three samples were used for model validation. In patients undergoing radical nephrectomy, biopsies of non-cancer kidney cortical tissue were also collected as a non-cancer control group. Spectroscopy data were analyzed using multivariate statistical analysis, including principal component analysis (PCA) and orthogonal projection to latent structures with discriminant analysis (OPLS-DA), to identify biomarkers in kidney cancer tissue that was also classified using the gold-standard of histopathology.ResultsThe data analysis methodology showed good separation between clear cell renal cell carcinoma (ccRCC) versus non-clear cell RCC (non-ccRCC) and non-cancer cortical tissue from the kidneys of tumor-bearing patients. Variable Importance for the Projection (VIP) values, and OPLS-DA loadings plots were used to identify chemical species that correlated significantly with the histopathological classification. Model validation resulted in the correct classification of 37/43 biopsy samples, which included the correct classification of 15/17 ccRCC biopsies, achieving an overall predictive accuracy of 86%, Those chemical markers with a VIP value >1.2 were further analyzed using univariate statistical analysis. A subgroup analysis of 47 tumor tissues arising from T1 tumors revealed distinct separation between ccRCC and non-ccRCC tissues.ConclusionsThis study provides metabolic insights that could have future diagnostic and/or clinical value. The results of this work demonstrate a clear separation between clear cell and non-ccRCC and non-cancer kidney tissue from tumor-bearing patients. The clinical translation of these results will now require the development of a one-dimensional (1D) magnetic resonance spectroscopy (MRS) protocol, for the kidney, using an in vivo clinical MRI scanner.

Redo Robotic Partial Nephrectomy for Recurrent Renal Tumors: A Multi-Institutional Analysis.

Introduction: As the experience with robot-assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RAPN in patients with a recurrent renal mass. Methods: Using a multi-institutional series, the data of 72 patients who underwent RAPN for a recurrent renal mass between 2010 and 2020 were retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication was defined by Clavien grade ≥3. The median follow-up was 28.5 months. Baseline demographics, clinical and tumor characteristics, and perioperative and postoperative outcomes are reported. Results: Our cohort consisted of a combination of previous thermal ablation (19.6%), laparoscopic (19.6%), open (26.1%), and robotic (34.8%) partial nephrectomy. The median R.E.N.A.L. score was 8. Twenty percent had hilar tumors and 9.7% had a solitary kidney. RAPN was completed in all cases. Two cases (2.8%) were converted to open surgery. None of the cases were converted to radical nephrectomy intraoperatively. One patient underwent radical nephrectomy postoperatively because of bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. Estimated glomerular filtration rate preservation was 78.7% at discharge and 90.8% at 1-year follow-up. Positive surgical margin rate was 8.3%. Overall, distant recurrence was seen in 11 patients (15.3%), however, only 1 patient had local progression (1.4%). Conclusion: In experienced hands, RAPN is an effective approach to treat select cases of locally recurrent renal masses with promising perioperative and functional outcomes. Patients should be carefully monitored for distant recurrence.

MP47-14 THE ROLE OF COMBINED SARCOPENIA AND ALBUMIN IN THE SURGICAL PROGNOSTICATION OF LOCALLY ADVANCED RENAL CELL CARCINOMA WITH VENOUS TUMOR THROMBUS

You have accessJournal of UrologyCME1 May 2022MP47-14 THE ROLE OF COMBINED SARCOPENIA AND ALBUMIN IN THE SURGICAL PROGNOSTICATION OF LOCALLY ADVANCED RENAL CELL CARCINOMA WITH VENOUS TUMOR THROMBUS Eric Midenberg, Dattatraya Patil, Alexandra Medline, Michelle Higgins, Milton Williams, Sarah P. Psutka, Kenneth Ogan, Mehmet A. Bilen, and Viraj A. Master Eric MidenbergEric Midenberg More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Alexandra MedlineAlexandra Medline More articles by this author , Michelle HigginsMichelle Higgins More articles by this author , Milton WilliamsMilton Williams More articles by this author , Sarah P. PsutkaSarah P. Psutka More articles by this author , Kenneth OganKenneth Ogan More articles by this author , Mehmet A. BilenMehmet A. Bilen More articles by this author , and Viraj A. MasterViraj A. Master More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Baseline evaluation of skeletal muscle index (SMI; cm2/m2) and serum albumin have demonstrated value in the preoperative risk assessment of patients with renal cell carcinoma (RCC). We hypothesize that sarcopenia, defined as a critical deficiency in skeletal muscle mass, and hypoalbuminemia will be associated with decreased overall survival (OS) and cancer specific survival (CSS) in nonmetastatic RCC patients undergoing radical nephrectomy and tumor thrombectomy. METHODS: We retrospectively analyzed 103 nonmetastatic RCC patients who underwent radical nephrectomy and tumor thrombectomy from 2005 to 2020. Optimally fit body mass index (BMI; kg/m2) and sex-stratified sarcopenia thresholds were calculated: BMI<30, SMI <47 for males and SMI <38 for females; BMI≥30, SMI<54 for males and SMI <47 for females. Sarcopenia and albumin risk groups were created based on their individual hazard ratios in univariable analysis and defined as low-risk (non-sarcopenic, normal albumin), medium-risk (hypoalbuminemia only), high-risk (sarcopenia only), and very high-risk (sarcopenia, hypoalbuminemia). Multivariable and Kaplan-Meier analyses were used to determine associations between independent and combined sarcopenia and hypoalbuminemia (albumin <3.5 g/dL) with OS and CSS. RESULTS: Preoperatively, 51.2% and 44.7% of our cohort had sarcopenia and hypoalbuminemia, respectively. In the independent multivariable analysis, sarcopenia was significantly associated with decreased OS (p=0.003) and CSS (p=0.006) whereas no relationship between hypoalbuminemia and OS and CSS was found (OS: p=0.096; CSS: p=0.718). In a separate model analyzing the combined sarcopenia and albumin risk groups, the high and very high-risk groups were significantly associated with decreased OS (high-risk: p=0.011; very high-risk: p <0.001) and CSS (high-risk: p=0.011; very high-risk: p=0.017). Kaplan-Meier curves showed a stepwise decline in median OS (p=0.007) and CSS (p=0.007) times with increasing risk. CONCLUSIONS: Simultaneous preoperative sarcopenia and hypoalbuminemia conveyed nearly a seven-fold decrease in OS and CSS in patients undergoing surgery for nonmetastatic RCC with venous tumor thrombus. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e815 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Midenberg More articles by this author Dattatraya Patil More articles by this author Alexandra Medline More articles by this author Michelle Higgins More articles by this author Milton Williams More articles by this author Sarah P. Psutka More articles by this author Kenneth Ogan More articles by this author Mehmet A. Bilen More articles by this author Viraj A. Master More articles by this author Expand All Advertisement PDF DownloadLoading ...

The clinicopathological profile of Renal cell carcinoma at BP Koirala Memorial Cancer Hospital

Introduction: Renal cell carcinoma accounts for 3-5%of all oncological diagnoses. In this study, we aim to assess the clinicopathological profile of Renal cell carcinoma in a cancer hospital of Nepal. Method: This is a retrospective study conducted at BP Koirala Memorial Cancer hospital Nepal. All patients with localized and locally advanced RCC who underwent radical or partial nephrectomy at our hospital between Jan 2012 to Dec 2018 were included. Normally distributed continuous variables were expressed as median, mean ± standard deviation (SD). Categorical variables were expressed as frequencies and percentages of an appropriate denominator. Results: Among 94 patients with RCC, the median age was 55 years (53.56 ±12.83). Most of the patients were male (56.4%, n=53) and Hindu by religion (67.02%, n=63). Eighty-three percent (n=78) of patients were smokers, 58.5 % (n=55) were hypertensive and 40.4% (n= 38) had history of diabetes mellitus. The most common symptom was incidental renal mass (42.55%, n=40). Ninety-five percent (n=89) of the patients underwent radical nephrectomy and five percent (n=5) of the patients underwent partial nephrectomy. The median duration of postoperative hospital stay was 8 days. The most common histological finding was Clear cell type (86.17, n=81) followed by papillary cell type (10.63%, n= 10) followed by chromophobe type (2.12%, n=2), and duct of Bellini( 1.06%, n=1). Most of the patients had pathological T2 (41.48%, n=39) disease followed by T3 (26.59%, n=25) disease. Conclusion: Smoker males in the fifth to sixth decade of life are at risk for developing RCC. Radical Nephrectomy is the standard of care with Clear cell carcinoma as the most common histological subtype.

SURGICAL TREATMENT OF MEDICATION RELATED OSTEONECROSIS OF THE JAW USING PRF

Medication related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive therapy with increasing incidence and is defined as a condition of progressive bone destruction in the maxillofacial region of patients. Antiresorptive drugs such as denosumab promotes the inhibition of osteoclast differentiation and function and is commonly used to treat bone cancer1. This report aims to present a case of MRONJ in a 76-year-old male patient who suffered from metastatic clear cell renal cell carcinoma (ccRCC). The patient underwent radical nephrectomy and was given, among other drugs, denosumab. After 1 year, he visited to clinic with exposed and necrotic bone that probes to bone, associated with infection as evidenced by pain in the region of the exposed bone and, subsequently, the diagnosis was MRONJ Stage 2. The necrosis was treated surgically with the addition of an autologous platelet concentrate (platelet-rich fibrin, PRF). Wound healing, pain and oral health-related quality of life were assessed via clinical evaluation after 7, 14, 30 days, 3 and 6 months postoperative. In conclusion, antiresorptive medications have close association to MRONJ in patients with poor oral hygiene and the antiresorptive treatment is recommended that should start after a careful dental preparation. Moreover, concerning MRONJ treatment, this case report indicate that when PRF is combined with successful surgical care, it can improve wound healing and has very promising results in tissue repair, regeneration, and growth.

Chronic kidney damage pathology score for systematic assessment of the non-neoplastic kidney tissue and prediction of post-operative renal function outcomes

To establish a systematic histological assessment of non-neoplastic kidney (NNK) tissue at the time of nephrectomy to evaluate a patient's risk of developing post-operative renal dysfunction, a combined prospective pathologic assessment of the NNK and a retrospective clinical chart review was conducted. A blinded nephropathologist performed standardized assessment of glomerular sclerosis, tubulointerstitial fibrosis, arteriosclerosis, and hyaline arteriolosclerosis. Combined these formulated the chronic kidney damage pathology score (CKDPS). Multivariate logistic regression models were developed to assess the effect of CKDPS and other clinical factors on renal function up to 24 months following nephrectomy (partial or radical). 156 patients were included in the analysis with a median age of 60 years. 70% patients underwent radical nephrectomy. A history of hypertension and/or diabetes was present in 55.8% and 22.1%, respectively. Higher CKDPS (particularly glomerular global sclerosis and arteriosclerosis scores), radical nephrectomy, and reduced baseline estimated glomerular filtration rate (eGFR) were associated with worsening post-operative renal function outcomes. The systematic assessment of non-neoplastic kidney tissue at the time of renal surgery can help identify patients at risk of post-operative renal dysfunction. CKDPS represents a standardized and prognostically relevant histologic reporting system for non-neoplastic kidney tissue.

Survival after minimally invasive vs. open radical nephrectomy for stage I and II renal cell carcinoma

A recently reported phase III randomized trial comparing open and minimally invasive hysterectomy showed significantly higher rates of local recurrence after minimally invasive surgery (MIS) for cervical cancer. This raised concerns regarding patterns of recurrences and survival after MIS in general. This study aims to determine the effect of MIS on all-cause mortality among patients undergoing radical nephrectomy for Stage I and II renal cell carcinoma (RCC). We utilized the National Cancer Database to identify patients diagnosed with clinical stage I-II RCCs between 2010 and 2013. Patients for whom a laparoscopic or robotic radical nephrectomy was attempted were compared to patients who underwent open radical nephrectomy (ORN). Adjusted regression models with inverse probability propensity score weighting (IPW) were utilized to identify independent predictors of receiving MIS. All-cause mortality rates were compared using IPW survival functions and log-rank tests. Adjusted Cox proportional hazard models were fitted to determine independent predictors of OS. 27,642 patients were identified; 11,524 (41.7%) had MIS, while 16,118 (58.3%) had ORN. Kaplan-Meier survival curves in the IPW cohort showed significant OS advantage for patients who underwent MIS (p < 0.001). Furthermore, length of hospital stays (3 vs. 4days), 30day readmission rates (2.4 vs. 2.87%), 30day (0.53 vs. 0.96%) and 90day mortality rates (1.04 vs. 1.77%) were significantly higher in the ORN group (p < 0.001). MIS was associated with better OS outcomes compared to ORN for stage I and II RCC. In addition, MIS had lower post-operative readmission, 30- and 90day mortality rates.