Trends in the incidence of benign pathological lesions at partial nephrectomy for presumed renal cell carcinoma in renal masses on preoperative computed tomography imaging: A single institute experience with 290 consecutive patients

Objective: The aim of this study was to determine trends in the incidence of benign lesions in patients undergoing surgery for suspicious renal masses on preoperative computed tomography scan. Methods: The records of 1065 patients who underwent open consecutive partial nephrectomy (PN) or radical nephrectomy (RN) between January 2001 and December 2008 were reviewed. Patients who underwent PN during the periods 2001–2002, 2003–2004, 2005–2006, and 2007–2008 were assigned to groups 1, 2, 3 and 4, respectively. The frequencies of benign and malignant lesions in these groups were assessed according to size and histology subtypes. Results: The ratio of PN to RN was 12.4%, 18.3%, 24.3% and 37.2% in groups 1, 2, 3 and 4, respectively (P < 0.05). The mean size of resected lesions was 2.6 cm (range 0.8–6.2 cm). Of the 290 cases, histopathology revealed benign findings in 52 (17.9%). Benign pathology was found in three of 18 cases (16.7%) in group 1, seven of 36 cases (19.4%) in group 2, 12 of 63 cases (19.0%) in group 3 and 30 of 173 cases (17.3%) in group 4. There was no significant difference in the frequency of benign histology among groups. Conclusion: PN, as opposed to RN, has shown a rising tendency over time. The frequency of benign pathology findings after PN for suspicious renal masses on preoperative computed tomography imaging has not decreased. Proper management should favor nephron‐sparing surgery for renal lesions if such lesions can be removed satisfactorily with PN.     

Retroperitoneoscopic live‐donor nephrectomy: 5‐year single‐center experience in China

Objective: To evaluate the efficacy and the learning‐curve period of our modified retroperitoneoscopic live‐donor nephrectomy. Methods: From December 2003 to May 2009, 138 consecutive retroperitoneoscopic live‐donor nephrectomies were carried out at our institution. Donors were separated into four groups in consecutive sequence in order to determine the learning‐curve period. Groups 1–3 included forty consecutive cases each, whereas group 4 included the last eighteen cases. The renal artery and vein were controlled with two plastic locking clips at proximal ends without any clips on the kidney side. The kidney was manually retrieved through lumbar incision. Results: Mean operative times were 160.5, 116.9, 101.4 and 109.2 min in groups 1–4, respectively (group 1 vs group 2, 3 or 4, P < 0.01). Mean warm ischemic time was 3.5 min. Mean estimated blood loss was 88.8, 73.0, 69.3 and 43.9 mL in groups 1–4, respectively (group 1 vs group 4, P < 0.01). No blood transfusion or open conversion was required. Mean hospital stay was 7.8, 6.9, 6.6 and 5.8 days in groups 1–4, respectively (group 1 vs group 4, P < 0.05). Eight donors and seven grafts suffered from complications. Complication rates were 22.5%, 7.5%, 5.0% and 6.0% in groups 1–4, respectively (group 1 vs group 3, P < 0.05). Conclusion: Our modified retroperitoneoscopic live‐donor nephrectomy can be carried out safely with a learning‐curve period of about 40 cases.     

Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron‐sparing surgery or radical nephrectomy for renal tumours larger than 4 cm

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The incidence of renal tumours is rising constantly. Patients in the 6th or 7th decade of life are mainly affected. Nephron‐sparing surgery (NSS) has become the gold standard for the treatment of patients presenting with renal tumors ≤4 cm and is recommended for cT1b lesions in experienced centers. Little is known about the functional outcome of elderly patients presenting with renal tumours larger than 4 cm and being treated by NSS in comparison to radical nephrectomy (RN). Here we could show that NSS can be performed safely with considerable perioperative morbidity and a better functional outcome according to renal function without lacking oncological control.

OBJECTIVE

To analyse renal function, perioperative morbidity and overall survival (OS) in patients aged <55 years compared with patients aged >65 years treated by radical nephrectomy (RN) or elective nephron‐sparing surgery (NSS) for renal tumours >4 cm.

PATIENTS AND METHODS

From our database, we identified 829 patients with renal tumours >4 cm treated by either RN (n= 641) or NSS (n= 188) at our institution between 1981 and 2007. After excluding patients with imperative indication and metastases, we identified retrospectively 81 patients aged <55 years (young patients) and 85 patients aged >65 years (elderly patients) treated for renal tumours >4 cm. In all, 36 and 33 patients underwent NSS and 45 and 52 patients underwent RN in the young and elderly group, respectively. Preoperative and periodically postoperative serum creatinin values were used to estimate glomerular filtration rate (GFR). Chronic kidney disease (CKD) was defined as GFR <60 mL/min/1.73 m². Clinical characteristics, complications and renal function were compared between age groups and surgical approaches, and OS was estimated using the Kaplan–Meier method.

RESULTS

The median (range) tumour size in young patients was larger compared with that of elderly patients, i.e. 6 (4.2–14.0) cm vs 5 (4.2–16.0) cm, with P < 0.001 considered to be statistically significant. The complication rates did not differ between the age groups (P= 0.656) or between NSS and RN in young (P= 0.095) or elderly patients (P= 0.277). Chronic kidney disease after RN or NSS occurred in 31.1% and 15.5% for young patients, respectively and in 50.9% and 24.2% in elderly patients, respectively, until last available follow‐up which was obtained after a median (range) of 5.69 (0.1–19.2) years for young patients and 5.48 (0.8–18.1) years for elderly patients. Overall survival did not significantly differ between NSS vs RN in young (P= 0.655) and elderly patients (P= 0.058).

CONCLUSION

Our findings suggest that performing NSS for tumours >4 cm when feasible in young and carefully selected elderly patients is more beneficial for maintaining long‐term renal function. Regardless of age, patients undergoing RN for renal tumours >4 cm developed more new onsets of CKD than patients treated by elective NSS. The complication rate did not differ between the age groups or between types of surgery.     

Characteristics and clinical outcomes of renal cell carcinoma in children: A single center experience

The present study aimed to assess the clinicopathological characteristics and the prognosis of renal cell carcinoma (RCC) in children. We retrospectively reviewed the medical records of 11 Korean children (7 boys and 4 girls) undergoing radical nephrectomy for RCC between September 1997 and January 2008 at our institution. Mean age at diagnosis was 12.7 years. The presenting clinical signs and symptoms included gross hematuria (55%), abdominal mass (45%) and abdominal pain (45%). Two (18%) of the cases were discovered incidentally. Five (45%) were conventional clear cell, four (36%) were papillary, one was a chromophobe and one was a translocation carcinoma. Seven children were T1N0M0, three were T2N0M0 and one child was T1N1M0. While one patient with T2 disease died of disease 89 months postoperatively, the remaining 10 patients, including a patient with regional nodal disease who received adjuvant immunochemotherapy, survived without evidence of recurrence at a mean follow‐up of 6.8 years. Our data suggest that the clinical presentation, pathological characteristics and clinical behavior of pediatric RCC are different from those of adult RCC.     

Long‐term critical issues in pediatric renal transplant recipients: a single‐center experience

Data on long‐term outcomes after pediatric renal transplantation (Tx) are still limited. We report on a 20‐year single‐center experience. Medical charts of all consecutive pediatric Tx performed between 1987 and 2007 were reviewed. Data of patients who had been transferred to adult units were extracted from the French databases of renal replacement therapies. Outcomes were assessed using Kaplan–Meier and Cox models. Two hundred forty Tx were performed in 219 children (24.1% pre‐emptive and 17.5% living related donor Tx). Median age at Tx was 11.1 years and median follow‐up was 10.4 years. Patient survival was 94%, 92%, and 91% at 5, 10, and 15 years post‐Tx, respectively. Overall, transplant survival was 92%, 82%, 72%, and 59% at 1, 5, 10, and 15 years post‐Tx, respectively. The expected death‐censored graft half‐life was 20 years. Sixteen patients developed malignancies during follow‐up. Median height at 18 years of age was 166 cm in boys and 152 cm in girls with 68% of patients being in the normal range. The proportion of socially disadvantaged young people was higher than in general population. Excellent long‐term outcomes can be achieved in pediatric renal Tx, but specific problems such as malignancies, growth, and social outcome remain challenging.     

Long-term follow-up of renal transplantation in children: A 20-year experience at one kidney center in Japan

Background

We reviewed the results of renal transplantation in children who has received transplants between October 1973 and January 1984 at our center.

Methods

Twenty-six children, 4 to 15 years of age, underwent renal transplantation from livingrelated donors and were treated using conventional immunosuppressive drugs.

Results

Patient survival rates were 96% at 5 years and 88% at 10 years. Graft survival rates were 69% at 5 years and 45% at 10 years. Four patients died. The main cause of graft loss was chronic rejection. One patient lost the graft due to recurrence of the original disease. Henoch-Schönlein purpura nephritis. The graft was functioning at the end of follow-up in 7 patients, and their serum creatinine levels were all below 1.6 mg/dL at the last follow-up. Noncompliance with medication was confirmed in 4 patients. There was no uncontrollable hypertension observed in any case. Children younger than 5 years showed catch-up growth, but overal growth in these children with renal transplants without growth hormone therapy was not good.

Conclusion

The long-term prognosis of children who underwent living-related renal transplantation using conventional immunosuppressive drugs was favorable, compared to that of adults.