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Objectives: Lymphocyte activation gene 3 (LAG3), an inhibitory receptor in T‐cell activation, is a negative prognostic factor. However, its impact on tumours has yet to be comprehensively elucidated on a pan‐cancer scale. Thus, we aim to reveal its role at the pan‐cancer level. Methods: We performed IHC staining on a retrospective cohort of 370 patients. Then we assessed the prognostic effect of LAG3 using Kaplan–Meier survival analysis and multivariate Cox regression analysis. In pan‐cancer analysis, we constructed competing endogenous RNA and protein–protein interaction networks, conducted gene set enrichment analysis and identified correlations between LAG3 gene expression and various factors, including clinical characteristics, tumour purity, mutations, tumour immunity and drug sensitivity across 33 cancer types. Results: LAG3 was expressed higher in normal kidney tissues than in tumours. A high level of LAG3 gene expression was an independent prognostic factor for OS (HR = 6.60, 95% CI = 2.43–17.90, P < 0.001) and PFS (HR = 3.44, 95% CI = 1.68–7.10, P < 0.001). In pan‐cancer analysis, LAG3 exhibited robust correlations with survival and tumour stages in various cancers. Moreover, LAG3 was strongly associated with immune‐related genes, proteins and signalling pathways. LAG3 gene expression was positively associated with increased infiltration of activated immune cells and decreased infiltration of several resting cells. LAG3 gene expression was associated with tumour mutation burden and microsatellite instability in multiple cancers. Conclusion: High LAG3 gene expression was an independent risk factor in kidney neoplasms. It also functioned as a biomarker for prognosis, TIME and immunotherapy efficacy in the pan‐cancer dimension. [ABSTRACT FROM AUTHOR]

Abstract Background TSPAN7 is an important factor in tumor progression. However, the precise function of TSPAN7 and its role in pan-cancer are not clear. Methods Based on Xinhua cohort incorporating 370 patients with kidney neoplasm, we conducted differential expression analysis by immunohistochemistry between tumor and normal tissues, and explored correlations of TSPAN7 with patients’ survival. Subsequently, we conducted a pan-cancer study, and successively employed differential expression analysis, competing endogenous RNA (ceRNA) analysis, protein-protein interaction (PPI) analysis, correlation analysis of TSPAN7 with clinical characteristics, tumor purity, tumor genomics, tumor immunity, and drug sensitivity. Last but not least, gene set enrichment analysis was applied to identify enriched pathways of TSPAN7. Results In Xinhua cohort, TSPAN7 expression was significantly up-regulated (P-value = 0.0019) in tumor tissues of kidney neoplasm patients. High TSPAN7 expression was associated with decreases in overall survival (OS) (P-value = 0.009) and progression-free survival (P-value = 0.009), and it was further revealed as an independent risk factor for OS (P-value = 0.0326, HR = 5.66, 95%CI = 1.155–27.8). In pan-cancer analysis, TSPAN7 expression was down-regulated in most tumors, and it was associated with patients’ survival, tumor purity, tumor genomics, tumor immunity, and drug sensitivity. The ceRNA network and PPI network of TSPAN7 were also constructed. Last but not least, the top five enriched pathways of TSPAN7 in various tumors were identified. Conclusion TSPAN7 served as a promising biomarker of various tumors, especially kidney neoplasms, and it was closely associated with tumor purity, tumor genomics, tumor immunology, and drug sensitivity in pan-cancer level.

Background: TSPAN7 is an important factor in tumor progression. However, the precise function of TSPAN7 and its role in pan-cancer are not clear. Methods: Based on Xinhua cohort incorporating 370 patients with kidney neoplasm, we conducted differential expression analysis by immunohistochemistry between tumor and normal tissues, and explored correlations of TSPAN7 with patients' survival. Subsequently, we conducted a pan-cancer study, and successively employed differential expression analysis, competing endogenous RNA (ceRNA) analysis, protein-protein interaction (PPI) analysis, correlation analysis of TSPAN7 with clinical characteristics, tumor purity, tumor genomics, tumor immunity, and drug sensitivity. Last but not least, gene set enrichment analysis was applied to identify enriched pathways of TSPAN7. Results: In Xinhua cohort, TSPAN7 expression was significantly up-regulated (P-value = 0.0019) in tumor tissues of kidney neoplasm patients. High TSPAN7 expression was associated with decreases in overall survival (OS) (P-value = 0.009) and progression-free survival (P-value = 0.009), and it was further revealed as an independent risk factor for OS (P-value = 0.0326, HR = 5.66, 95%CI = 1.155–27.8). In pan-cancer analysis, TSPAN7 expression was down-regulated in most tumors, and it was associated with patients' survival, tumor purity, tumor genomics, tumor immunity, and drug sensitivity. The ceRNA network and PPI network of TSPAN7 were also constructed. Last but not least, the top five enriched pathways of TSPAN7 in various tumors were identified. Conclusion: TSPAN7 served as a promising biomarker of various tumors, especially kidney neoplasms, and it was closely associated with tumor purity, tumor genomics, tumor immunology, and drug sensitivity in pan-cancer level. [ABSTRACT FROM AUTHOR]

This study aimed to assess the surgical outcomes of single-layer versus double-layer renorrhaphy in robot-assisted laparoscopic partial nephrectomy (RAPN) performed by an experienced surgeon.We enrolled 655 patients who underwent RAPN between January 2019 and June 2023. After excluding those with multiple tumors or incomplete medical records, 554 patients were included in the final analysis. We compared surgical outcomes between single-layer renorrhaphy (outer cortical closure) and double-layer renorrhaphy (inner layer suture and outer cortical closure), adjusting for preoperative factors such as sex, age, body mass index, American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate (eGFR), preoperative complications (diabetes or hypertension), surgical approach (transperitoneal or retroperitoneal), tumor size, and tumor complexity, using propensity score matching. Of the 554 patients analyzed, 59 were classified into the single-layer group and 495 into the double-layer group. Before matching, the double-layer group had more complex and larger tumors. After matching, 58 patients were included in each group. The single-layer group showed significantly shorter operative times (91 min vs. 100 min, p = 0.0361), lower estimated blood loss (EBL) (7.9 ml vs. 27 ml, p = 0.021), and better preservation of eGFR (− 1.2% vs. − 5.1%, p = 0.0313). Other outcomes, such as perioperative complications and postoperative hospital stay, were not significantly different between the groups. Single-layer renorrhaphy demonstrated better surgical outcomes, including shorter operative time, lower EBL, and better preservation of kidney function, compared to double-layer renorrhaphy. These findings suggest that single-layer reconstruction may optimize RAPN outcomes in selected patients. [ABSTRACT FROM AUTHOR]

Background: With increasing detection of small renal masses and accumulating evidence that nephron sparing surgery (NSS) could achieve oncological equivalence and functional superiority compared with radical nephrectomy (RN), NSS has become first‐line therapy for some patients with localized renal masses. Objective: This study aims to review the publications in the kidney neoplasm and NSS field, exploring the research hotspots. Method: Kidney neoplasm and NSS related publications before July 3th 2023 were obtained from the Web of Science Core Collection database. We then used bibliometric analysis to conduct performance analysis, citation analysis and co‐citation network of publications, together with keyword co‐occurrence analysis. Results: Seven thousand five hundred and sixty‐four documents were finally retrieved, and the annual publications increased exponentially. The most productive authors were "KAOUK JH" and "GILL IS", while USA, and 12 American affiliations such as CLEVELAND CLINIC FOUNDATION and MAYO CLINIC were far leading in this field. Journal of Urology and European Urology were journals with the highest citations and h‐index. Discussion: Through literature reviewing plus co‐occurrence and clustering analysis, the therapeutic effects of partial nephrectomy (PN) versus RN on patients with localized renal cell carcinoma, different operative approaches of PN, and conservative NSS methods were deemed as the most focused topics. Conclusion: Three aspects were the most important hotspots in this field. Firstly, how to provide the optimal management choices for different patients. Secondly, therapeutic effects of different management options and surgical techniques needed more prospective and randomized studies. Finally, more novel technologies and surgical techniques were required. [ABSTRACT FROM AUTHOR]

Background Chronic kidney disease (CKD) is highly prevalent, affecting approximately 11% of US adults. Multiple studies have evaluated a potential association between CKD and urinary tract malignancies. Summary estimates of urinary tract malignancy risk in CKD patients with and without common co-existing conditions may guide clinical practice recommendations. Methods Four electronic databases were searched for original cohort studies evaluating the association between CKD and urinary tract cancers (kidney cancer and urothelial carcinoma) through 25 May 2023, in persons with at least moderate CKD and no dialysis or kidney transplantation. Quality assessment was performed for studies meeting inclusion criteria using the Newcastle-Ottawa Scale. Meta-analysis with a random-effects model was performed for unadjusted incidence rate ratios (IRR) as well as adjusted hazard ratios (aHR) for confounding conditions (diabetes, hypertension and/or tobacco use), shown to have association with kidney cancer and urothelial carcinoma. Sub-analysis was conducted for estimates associated with CKD stages separately. Results Six cohort studies with 8 617 563 persons were included. Overall, the methodological quality of the studies was good. CKD was associated with both higher unadjusted incidence and adjusted hazard of kidney cancer (IRR 3.36, 95% confidence interval (CI) 2.32–4.88; aHR 2.04, 95% CI 1.77–2.36) and urothelial cancer (IRR 3.96, 95% CI 2.44–6.40; aHR 1.35, 95% CI 1.22–1.50) compared with persons without CKD. Examining incident urinary tract cancers by CKD severity, risks were elevated in stage 3 CKD (kidney aHR 1.89, 95% CI 1.56–2.30; urothelial carcinoma aHR 1.35, 95% CI 1.20–1.52) as well as in stages 4/5 CKD (kidney cancer aHR 2.30, 95% CI 2.00–2.66; urothelial carcinoma aHR 1.24, 95% CI 1.04–1.49). Conclusions Even moderate CKD is associated with elevated risk of kidney cancer and urothelial carcinoma. Providers should consider these elevated risks when managing individuals with CKD, particularly when considering evaluation for the presence and etiology of hematuria. [ABSTRACT FROM AUTHOR]

Abstract Cancers of the kidney and renal pelvis are among the most prevalent types of urinary cancers. We aimed to outline the incidence trends of kidney and renal pelvis cancers by age, sex, race/ethnicity, and histology in the United States (US) from 2000 to 2020. The data was obtained from the Surveillance, Epidemiology, and End Results (SEER) 22 database. The identification of patients with kidney and renal pelvis cancers with morphologies of renal cell carcinoma, nephroblastoma, sarcoma, and neuroendocrine tumor was conducted utilizing the International Classification of Diseases for Oncology version 3. The average annual percent change (AAPC) were presented. All estimates were given in the form of counts and delayed age-standardized incidence rates (ASIRs) per 100,000 people. From 2000 to 2019, a total of 490,481 cases of kidney and renal pelvic cancer were recorded across all age groups in the US. The majority of them were among Non-Hispanic Whites (NHWs) (69.75%) and those aged 55–69 years (39.96%). The ASIRs per 100,000 for kidney and pelvis cancers were 22.03 for men and 11.14 for women. Non-Hispanic Black men had the highest ASIR (24.53 [24.24, 24.81]), and increase in ASIR over the 2000–2019 period (AAPC: 2.19% [1.84, 2.84]). There was a noticeable increase in incidence of kidney and renal pelvis cancers. Individuals aged 70–84 years had the highest ASIR for kidney and renal pelvis cancers. The COVID-19 era has resulted in a significant reduction in incidence rates across all demographics.

Cancers of the kidney and renal pelvis are among the most prevalent types of urinary cancers. We aimed to outline the incidence trends of kidney and renal pelvis cancers by age, sex, race/ethnicity, and histology in the United States (US) from 2000 to 2020. The data was obtained from the Surveillance, Epidemiology, and End Results (SEER) 22 database. The identification of patients with kidney and renal pelvis cancers with morphologies of renal cell carcinoma, nephroblastoma, sarcoma, and neuroendocrine tumor was conducted utilizing the International Classification of Diseases for Oncology version 3. The average annual percent change (AAPC) were presented. All estimates were given in the form of counts and delayed age-standardized incidence rates (ASIRs) per 100,000 people. From 2000 to 2019, a total of 490,481 cases of kidney and renal pelvic cancer were recorded across all age groups in the US. The majority of them were among Non-Hispanic Whites (NHWs) (69.75%) and those aged 55–69 years (39.96%). The ASIRs per 100,000 for kidney and pelvis cancers were 22.03 for men and 11.14 for women. Non-Hispanic Black men had the highest ASIR (24.53 [24.24, 24.81]), and increase in ASIR over the 2000–2019 period (AAPC: 2.19% [1.84, 2.84]). There was a noticeable increase in incidence of kidney and renal pelvis cancers. Individuals aged 70–84 years had the highest ASIR for kidney and renal pelvis cancers. The COVID-19 era has resulted in a significant reduction in incidence rates across all demographics. [ABSTRACT FROM AUTHOR]

Aim: We compared survival and perioperative outcomes of robot‐assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic radical nephrectomy (LRN) for older patients (age 70 years or older) with stage 1 renal cell carcinoma (RCC). Methods: This retrospective, single‐center study included 260 patients who underwent RAPN and 44 patients who underwent LRN. The overall survival (OS) and perioperative outcomes were compared between these two groups using an inverse probability of treatment weighting (IPTW) analysis. Results: Compared with the LRN group, a trend of more complications was observed in the RAPN group, including a higher body mass index (24 vs. 22 kg/m2; P = 0.0002) and higher rates of hypertension (77% vs. 55%; P = 0.0029) and chronic kidney disease (62% vs. 36%; P = 0.0027). After adjustment by the IPTW analysis, the RAPN group had a shorter operative time (143 vs. 282 min; P = 0.033), shorter postoperative length of hospital stay (PLOS) (4.1 vs. 7.9 days; P = 0.004), and less change in the estimated glomerular filtration rate during surgery (−8.4% vs. −32%; P < 0.0001) than the LRN group; however, the perioperative complication rates were similar. Patients who underwent RAPN had better 5‐year OS than those who underwent LRN (95% vs. 90%; log‐rank, P = 0.017). Conclusion: RAPN resulted in better OS and surgical outcomes, with shorter operative time, shorter PLOS, and better renal function preservation, than LRN for older patients with stage 1 RCC. Therefore, RAPN may be the primary option for patients indicated for surgical intervention. Geriatr Gerontol Int 2024; 24: 269–274. [ABSTRACT FROM AUTHOR]

Purpose - Recent improvements in the treatment of renal cell carcinoma (RCC), with the introduction of targeted agents, have increased the need of accurate data on its epidemiology. This descriptive study was designed to collate comprehensive information on RCC epidemiology from North Africa and the Middle East, which could provide the basis for further research. Methods - A network of reference oncologists in North Africa and the Middle East were invited to share all available national and regional information on RCC epidemiology, captured in a comprehensive questionnaire. No statistical analysis was planned as the intention was to conduct a purely descriptive study. Results - The results reported that the incidence of RCC within the region is in the range of 0.9–2.35/100,000 for men (with Lebanon as an exception at 4.3/100,000 for men) and 0.5– 1.7/100,000 for women, which is considerably lower than in Europe and the USA. No mortality or survival data are available. The age at diagnosis (mean < 60 years) is lower than in Western countries and a high proportion of patients in North Africa and the Middle East (21‒45%) have metastatic disease at diagnosis. Conclusions - The information presented here provides a more complete and current picture of RCC in North Africa and the Middle East; however, there are still gaps in the data. Further research is needed to allow planning of treatment strategies and resource allocation.

Abstract Background With increasing detection of small renal masses and accumulating evidence that nephron sparing surgery (NSS) could achieve oncological equivalence and functional superiority compared with radical nephrectomy (RN), NSS has become first‐line therapy for some patients with localized renal masses. Objective This study aims to review the publications in the kidney neoplasm and NSS field, exploring the research hotspots. Method Kidney neoplasm and NSS related publications before July 3th 2023 were obtained from the Web of Science Core Collection database. We then used bibliometric analysis to conduct performance analysis, citation analysis and co‐citation network of publications, together with keyword co‐occurrence analysis. Results Seven thousand five hundred and sixty‐four documents were finally retrieved, and the annual publications increased exponentially. The most productive authors were “KAOUK JH” and “GILL IS”, while USA, and 12 American affiliations such as CLEVELAND CLINIC FOUNDATION and MAYO CLINIC were far leading in this field. Journal of Urology and European Urology were journals with the highest citations and h‐index. Discussion Through literature reviewing plus co‐occurrence and clustering analysis, the therapeutic effects of partial nephrectomy (PN) versus RN on patients with localized renal cell carcinoma, different operative approaches of PN, and conservative NSS methods were deemed as the most focused topics. Conclusion Three aspects were the most important hotspots in this field. Firstly, how to provide the optimal management choices for different patients. Secondly, therapeutic effects of different management options and surgical techniques needed more prospective and randomized studies. Finally, more novel technologies and surgical techniques were required.

This study aims to highlight the differences in adverse events (AEs) between cabozantinib (CAB) plus nivolumab (NIVO) versus ipilimumab (IPI) plus NIVO. We used the FAERS database. Drugs presented a disproportionate distribution of toxicities. Serious AEs were higher in patients receiving IPI + NIVO. These findings may help clinicians select therapy and improve the safety profile. Introduction: Recently, many agents and combinations for metastatic and advanced renal cell carcinoma have been approved. This study aims to highlight the comprehensive differences in adverse events (AEs) between cabozantinib (CAB) plus nivolumab (NIVO) and ipilimumab (IPI) plus NIVO based on a real-world big dataset. Material and Methods: We downloaded AE datasets of IPI + NIVO and CAB + NIVO from the Food and Drug Administration Adverse Event Reporting System database. We used the Medical Dictionary for Regulatory Activities to treat each AE as a preferred term and grouped it into the System Organ Class (SOC). We performed logistic regression analyses to compare IPI + NIVO and CAB + NIVO. Results: The incidence rates of 7 types of toxicities were higher for CAB + NIVO than for IPI + NIVO. On the other hand, the incidence rates of 3 types of toxicities were higher for IPI + NIVO than for CAB + NIVO. Serious AEs were higher in patients receiving IPI + NIVO. Conclusion: Our findings suggest that both combination therapies presented a disproportionate distribution of toxicities in several SOC. These findings may help clinicians select suitable therapy for the individual and improve the safety profile in patients with advanced renal cell carcinoma receiving NIVO + IPI and NIVO + CAB in a real-world setting. [ABSTRACT FROM AUTHOR]

Mixed epithelial and stromal tumor (MEST) of the kidney is not a common diagnosis. This tumor usually mimics solid-cystic malignant renal tumors and most cases are treated surgically. Here, we presented a 35-year-old female with simultaneous two separate large solid-cystic masses with contrast enhancement in lower and upper pole of left kidney which were managed surgically via partial nephrectomy. Microscopic evaluation showed solid-cystic tumor with variably sized cysts lined by flattened to cuboidal epithelium that was compatible with MEST. Follow up evaluation revealed normal parenchymal renal tissue and proper function without any evidence of local recurrence.

To present a patient with horseshoe kidney and bilateral squamous cell carcinoma (SCC) which has not been reported so far. A 61-year-old woman presented with abdominal mass and recent episodes of gross hematuria. Imaging revealed malignant lesion of lower calyces of the right kidney and isthmus of horse-shoe kidney with midline crossing to the left side. Finally, the patient underwent bilateral enbloc radical nephroureterectomy and pathology evaluation was compatible with bilateral squamous cell carcinoma. This is the first report of bilateral SCC in horseshoe kidney which was managed via open enbloc radical nephroureterectomy.

Introduction and Objective: Robot-assisted radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN), but there are concerns over costs and objective benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, perioperative outcomes of RRN, LRN, and ORN for very large renal masses are compared. Methods: Using the National Cancer Database, patients were identified who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010 to 2015. Patients were analyzed according to surgical approach. Perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30- and 90-day mortality were compared among cohorts. Results: A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). Compared with ORN, recipients of RRN or LRN had similar rates of 30-day readmission and 30- and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ±0.19; p

Abstract Objectives Lymphocyte activation gene 3 (LAG3), an inhibitory receptor in T‐cell activation, is a negative prognostic factor. However, its impact on tumours has yet to be comprehensively elucidated on a pan‐cancer scale. Thus, we aim to reveal its role at the pan‐cancer level. Methods We performed IHC staining on a retrospective cohort of 370 patients. Then we assessed the prognostic effect of LAG3 using Kaplan–Meier survival analysis and multivariate Cox regression analysis. In pan‐cancer analysis, we constructed competing endogenous RNA and protein–protein interaction networks, conducted gene set enrichment analysis and identified correlations between LAG3 gene expression and various factors, including clinical characteristics, tumour purity, mutations, tumour immunity and drug sensitivity across 33 cancer types. Results LAG3 was expressed higher in normal kidney tissues than in tumours. A high level of LAG3 gene expression was an independent prognostic factor for OS (HR = 6.60, 95% CI = 2.43–17.90, P

Objective: Renal cell carcinomas represent the sixth- and tenth-most frequently diagnosed cancer in men and women. Recently, percutaneous-guided thermal ablations have proved to be as effective as partial nephrectomy and safer for treating small renal masses (i.e., < 3 cm). This study compared the perioperative and recurrence outcomes of percutaneous thermal ablation (TA) and robotic-assisted partial nephrectomy (RAPN) for the treatment of T1b renal cell carcinomas (4.1–7 cm). Methods: Retrospective data from 11 centers on the national database, between 2010 and 2020, included 81 patients treated with thermal ablation (TA) and 308 patients treated with RAPN for T1b renal cell carcinoma, collected retrospectively and matched for tumor size, histology results, and the RENAL score. TA included cryoablation and microwave ablation. Endpoints compared the rate between the two groups: local recurrence, metastases, complications, renal function decrease, and length of hospitalization. Results: After matching, 75 patients were included in each group; mean age was 76.6 (± 9) in the TA group and 61.1 (± 12) in the RAPN group, including 69.3% and 76% men respectively. The local recurrence (LR) rate was significantly higher in the TA group than in the PN group (14.6% vs 4%; p = 0.02). The LR rate was 20% (1/5) after microwave ablation, 11.1% (1/9) after radiofrequency ablation, and 14.7% (9/61) after cryoablation. The major complication rate (Clavien–Dindo ≥ 3) was higher following PN than after TA (5.3% vs 0%; p < 0.001). Metastases, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. Conclusions: The local recurrence rate was significantly higher after thermal ablation; however, thermal ablation resulted in significantly lower rates of complications. Summary statement: Thermal ablation and robotic-assisted partial nephrectomy are effective treatments for T1b renal cancer; however, the local recurrence rate was higher after thermal ablation. Key Points: • The local recurrence rate was significantly higher in the thermal ablation group than in the partial nephrectomy group. • The major complication rate (Clavien–Dindo ≥ 3) was higher following PN than after TA (5.3% vs. 0%; p < 0.001). [ABSTRACT FROM AUTHOR]

Malignant priapism (MP) is defined as a condition of persistent erection of the penile without sexual stimulation due to malignant cell invasion to the cavernous sinus and the efferent veins. We present a case of a man, 63 years old, with previous history of high-grade renal carcinoma pT3N0M0 had been through radical nephrectomy, diagnosed with MP secondary from metastatic renal carcinoma. The management of this case was aspiration of corpora cavernosa and distal shunting with the Al-Ghorab procedure, then continued to total penectomy and perineostomy.

Purpose: To evaluate whether ablation volume difference relatively to tumoral volume, minimal distance between ablation area and necrotic tumor, or apparent diffusion coefficient (ADC) within the ablation area, measured on 1- and 3-month follow-up MRI following cryoablation of renal tumors, are associated with tumor recurrence. Materials and Methods: 136 renal tumors were retrospectively identified. Patients, tumor characteristics and follow-up MRI (1-, 3-, 6-month, and thereafter annually) were collected. Uni- and multivariate analyses were performed to assess the association between the investigated parameters and tumor recurrence. Results: Over the follow-up period (27.7 ± 21.9 months), 13 recurrences were identified at 20.5 ± 19.4 months. At 1- and 3-month, the mean volume difference between the ablation zone and the tumor volume were + 577.5 ± 511.3% vs + 251.4 ± 209.8% (p = 0.003), and + 268.8 ± 291.1% vs + 103.8 ± 94.6% (p = 0.023) in patients without and with tumor recurrence, respectively. At 1- and 3-month, the minimum distance between the necrotic tumor and the edge of the ablation area was 3.4 ± 2.5 vs 1.8 ± 1.9 mm (p = 0.019), and 2.4 ± 2.3 vs 1.4 ± 1.8 mm (p = 0.13) in patients without and with tumor recurrence, respectively. Analysis of ADC values was not associated with tumor recurrence. After performing the multivariate analysis, only volume difference of the ablation area compared to tumor volume was associated with absence of tumor recurrence at 1- (OR = 14.1; p = 0.001) and 3-month (OR = 8.2; p = 0.01). Conclusions: Evaluation of volume difference between the ablation area and tumor volume on early (≤ 3 months) MRI follow-up identifies patients at risk of tumor recurrence. [ABSTRACT FROM AUTHOR]

Objectives: Nephron-sparing surgery (NSS) exposes the kidney to ischemia–reperfusion injury. Blood loss and hypotension are also associated with kidney injury. We aimed to test the hypothesis that, during NSS, both ischemia duration and blood loss significantly affect postoperative renal function and that their effects interact. Methods: Consecutive patients undergoing NSS were enrolled. The primary endpoint was renal function expressed as the absolute delta between preoperative and postoperative peak creatinine. We developed a generalized linear model with the ischemia duration and absolute hemoglobin difference as independent variables, their interaction term, and the RENAL score. The model was than expanded to include a history of hypertension (as a proxy for hypotension susceptibility) and related interaction terms. Further, we described the perioperative and mid-term oncological outcomes. Results: A total of 478 patients underwent NSS, and 209 (43.7%) required ischemia for a mean of 10.9 min (SD 8). Both the ischemia duration (partial eta 0.842, p = 0.006) and hemoglobin difference (partial eta 0.933, p = 0.029) significantly affected postoperative renal function, albeit without evidence of a significant interaction (p = 0.525). The RENAL score also significantly influenced postoperative renal function (p = 0.023). After the addition of a previous history of hypertension, the effects persisted, with a significant interaction between blood loss and a history of hypertension (p = 0.02). Conclusions: Ischemia duration and blood loss had a similar impact on postoperative renal function, albeit without potentiating each other. While the surgical technique and ischemia minimization remain crucial to postoperative kidney function, increased awareness of conscious hemodynamic management appears warranted.

ObjectivesMany people are turning to alternatives to the conventional doctor-patient relationship, such as web-based search engines and video forums for their health care information. We undertook this study to investigate the quality of videos and information on renal cancer available on the streaming platform YouTube.MethodsWe completed a search of YouTube (w w w.YouTube.com) in September 2021 with the term “kidney cancer.” The first 120 videos found which met the inclusion criteria (English speaking, duration greater than one minute, greater than 500 views, renal cancer addressed) were selected. We recorded information including duration, view count, likes, dislikes, comments, publisher, and author. The modified DISCERN tool and Global Quality Score (GQS) questionnaire were used to assess the quality of the included videos. The level of misinformation was assessed using a Likert 5-point scale. Descriptive statistics were used to analyse the collected data. A 2-sample t test was used to further analyse the quality assessment tool results before, during, and after 2016.ResultsMost videos were published during or after 2016 (63.3%), were predominantly created in North America (77.5%), and were presented by health care professionals (60%). The median length of the videos was 4.23 (1.01 to 65.55) minutes, and the median number of views was 3087 (514 to 228 152). The median number of likes and dislikes was 24 and 5, respectively. The median modified DISCERN score was 3, the median GQS score was 3, and the grading for overall level of misinformation was moderate.ConclusionThe quality of information accessed from YouTube on kidney cancer is of a low to moderate overall standard with significant levels of misinformation. YouTube should not be used alone for educational purposes on renal cancer by patients or the public. It is best used in conjunction with information and advice from a medical practitioner and the health care system.

Primary renal synovial sarcoma is a rare malignancy that may present similarly to other renal neoplasms. The diagnosis of synovial sarcoma is performed through the identification of a SYT-SSX gene fusion. Here, we present a case of a primary renal synovial sarcoma in a patient who presented with renal mass initially thought to be renal cell carcinoma until further pathological characterization. After undergoing radical open nephrectomy, the patient developed pulmonary and psoas metastases and was treated with systemic therapy.

Mixed epithelial and stromal tumors of the kidney (MESTK) are rare and recently defined entities that comprise both epithelial and stromal cells. MESTK is mostly benign; however, to date, 18 borderline or malignant cases have been reported. In this study, we report a case of carcinosarcoma exhibiting a large carcinoma and small sarcoma component, and review the relevant literature. The patient was a 59-year-old woman who presented with a large mass in the left kidney having solid and focal cystic components. The patient underwent left radical nephrectomy. The tumor was gray-white and solid-cystic, with a relatively clear boundary. Microscopically, the tumor revealed benign and malignant components. The benign component consisted of multiple tubules, variable-sized cysts lined with benign epithelium, and hyalinized stroma. The malignant component was composed of predominantly small cell neuroendocrine carcinoma and a small quantity of adenocarcinoma, squamous cell carcinoma, and sarcoma. Finally, a diagnosis of the malignant MESTK was made. Certain cases of borderline or malignant transformation of MESTK have been published, so it is important to enhance findings made by other studies. [ABSTRACT FROM AUTHOR]

Objectives: Nephron-sparing surgery (NSS) exposes the kidney to ischemia–reperfusion injury. Blood loss and hypotension are also associated with kidney injury. We aimed to test the hypothesis that, during NSS, both ischemia duration and blood loss significantly affect postoperative renal function and that their effects interact. Methods: Consecutive patients undergoing NSS were enrolled. The primary endpoint was renal function expressed as the absolute delta between preoperative and postoperative peak creatinine. We developed a generalized linear model with the ischemia duration and absolute hemoglobin difference as independent variables, their interaction term, and the RENAL score. The model was than expanded to include a history of hypertension (as a proxy for hypotension susceptibility) and related interaction terms. Further, we described the perioperative and mid-term oncological outcomes. Results: A total of 478 patients underwent NSS, and 209 (43.7%) required ischemia for a mean of 10.9 min (SD 8). Both the ischemia duration (partial eta 0.842, p = 0.006) and hemoglobin difference (partial eta 0.933, p = 0.029) significantly affected postoperative renal function, albeit without evidence of a significant interaction (p = 0.525). The RENAL score also significantly influenced postoperative renal function (p = 0.023). After the addition of a previous history of hypertension, the effects persisted, with a significant interaction between blood loss and a history of hypertension (p = 0.02). Conclusions: Ischemia duration and blood loss had a similar impact on postoperative renal function, albeit without potentiating each other. While the surgical technique and ischemia minimization remain crucial to postoperative kidney function, increased awareness of conscious hemodynamic management appears warranted. [ABSTRACT FROM AUTHOR]

Abstract Objective The experience of performing robot-assisted partial nephrectomy (RAPN) is associated with better surgical outcomes. However, surgeon’s generation may impact surgical outcomes. We evaluated the perioperative outcomes of RAPN between first- and second-generation surgeons according to the surgeon’s experience. Methods This study included 529 patients who underwent RAPN for renal cell carcinoma from January 2013 to November 2018. Four specific surgeons performed the surgery. According to the surgeon’s generation, the patients were divided into two groups: first-generation and second-generation. To reflect the learning curve of RAPN, the surgical outcomes of each case (1–50, 51–100, 101–150) were evaluated between these groups. Results Between 1 to 50 cases and 101–150 cases, no significant differences in patient characteristics were observed between the two generations. Between 51–100 cases, age at surgery was significantly younger in the first-generation than in the second-generation group (58 years vs. 64 years, p = 0.04). The second-generation group had a shorter operation time in cases 1–50 (169 min vs. 188 min, p = 0.0001), 51–100 (145 min vs. 169 min, p = 0.008), and 101–150 (142 min vs. 165 min, p = 0.009), than the first-generation group. Although shorter WIT and higher trifecta achievement were observed in the second-generation group than in the first-generation group between 1–50 cases, the difference was not noted between 51–100 cases and 101–150 cases. Conclusion Patients operated by second-generation surgeons had better surgical outcomes than first-generation surgeons, especially during the early experience period, which might result from their assistance experience, sophisticated surgical procedures refined by the first-generation, and the first-generation surgeon’s introduction.

Cystic renal cell carcinoma (RCC) is a malignant epithelial tumor arising in a pre-existing renal cyst. The renal cyst maybe multilocular or unilocular with the latter being an even rarer occurrence. Cystic renal malignancy arising in a unilocular cyst is quite rare with only a few cases reported till date, most of which are clear cell RCCs. Literature available with regard to staging tumor nodule in a benign unilocular cyst is limited. We report a case of a 52-year-old male presenting with a single large unilocular cyst which had a small solid nodule of papillary RCC in its posterior wall which was detected on microsopy. On pathologic examination, all cases of clinically/ radiologically benign renal cysts should be examined with a high index of suspicion as a small tumor focus may be present in the form of a nodule or in the free wall of the cyst which was initially missed.

Purpose: We investigated operative time according to procedure phases in robot‐assisted laparoscopic partial nephrectomy (RAPN) and identify variables associated with longer operative time in each procedure phase. Methods: This retrospective, single‐center study included 108 patients who underwent RAPN conducted by an experienced surgeon. Operative time was divided into dissection, resection, tumor bed suture, and renorrhaphy and hemostasis phases, which were derived from the iPhone application "My Intuitives." Multivariate analyses were performed to identify possible predictors such as sex, body mass index, tumor complexity, and surgical approach for longer operative time in each phase. Results: The median console time was 65 min, and median operative times in dissection, resection, tumor bed suture, and renorrhaphy and hemostasis phases were 41, 8, 9, and 8 min, respectively. In the multivariate analysis, longer console time was observed in high complexity tumors (vs. low, OR: 8.01, 95% CI: 1.94–33.0) and transperitoneal approach (vs. retroperitoneal approach, OR: 3.62, 95% CI: 1.94–33.0). High complexity tumors were significantly associated with longer operative time in all procedure phases, and the male sex was associated with a longer operative time in the dissection phase than the female sex (OR: 3.61, 95% CI: 1.18–11.0). Conclusion: The identified significant predictive factors associated with longer operative time were the male sex and high complexity in the dissection phase, high complexity in the resection phase, in the tumor bed suture phase as well as in the renorrhaphy and hemostasis phase. These findings may help to predict the difficulty of performing RAPN in terms of operative time. [ABSTRACT FROM AUTHOR]

We provide the first scoping review on physical activity (PA) in patients with kidney cancer (KC). We identified only 17 published articles from nine independent studies, resulting in no firm conclusions. Evidence on the safety, feasibility, and efficacy (benefits and harms) of PA in patients with KC is lacking. Systematic research on this topic is warranted. Physical activity (PA) helps many cancer patients improve health-related fitness, treatment-related side effects, quality of life, and possibly survival; however, limited research has been conducted in patients with kidney cancer (KC). The aim of this scoping review focused on PA in patients with KC was to summarize current findings, delineate strengths and limitations, and provide key recommendations for future research. A scoping review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. The electronic databases of PubMed and Cochrane Library were screened for studies on October 14, 2021, and the search was updated on October 31, 2021. The data were abstracted and synthesized by study design. A total of 17 articles from nine independent studies were identified including 1 cross-sectional study (n = 8 articles), 1 randomized controlled trial (n = 2 articles) and 7 cohort studies (n = 7 articles). The cross-sectional study and randomized controlled trial reported on PA participation rates, preferences, social-cognitive correlates, and quality of life in patients with KC. The 7 cohort studies mostly reported on the risk of KC mortality in general population samples. Overall, no conclusions can be drawn from current research on the safety, feasibility, and efficacy (benefits and harms) of PA in patients with KC. Future research is urgently needed on PA in patients with KC, taking into account their unique disease- and treatmentrelated factors. This research is necessary to inform clinical exercise guidelines in this understudied cancer patient group. [ABSTRACT FROM AUTHOR]

Primary renal synovial sarcoma is a rare malignancy that may present similarly to other renal neoplasms. The diagnosis of synovial sarcoma is performed through the identification of a SYT-SSX gene fusion. Here, we present a case of a primary renal synovial sarcoma in a patient who presented with renal mass initially thought to be renal cell carcinoma until further pathological characterization. After undergoing radical open nephrectomy, the patient developed pulmonary and psoas metastases and was treated with systemic therapy. [ABSTRACT FROM AUTHOR]

Purpose: Emerging evidence supports the use of minimally invasive partial nephrectomy (MIPN) in ambulatory settings. We conducted a systematic review and meta-analysis to evaluate differences in perioperative characteristics, complication/readmission rates and satisfaction/cost data between ambulatory and standard-length discharge (SLD) MIPN. Methods: This study was prospectively registered in PROSPERO (CRD42023429854). A systematic literature search of PubMed, Embase, and Web of Science databases was conducted, including studies comparing ambulatory MIPN vs SLD MIPN for patients with renal masses. Studies were assessed for quality using the Methodological Index for Non-Randomized Studies score. Meta-analysis was performed for comparative studies, and non-comparative studies were included narratively. Results: Eleven studies were included with a pooled population of 20,548 patients, of which 1,419 (7%) had a length of stay less than 1 day and were considered the ambulatory group. There were no significant differences in the total complication rates (RR: 0.50, 95% CI: 0.24, 1.04; p = 0.06) or 30-day readmission rates (RR: 0.87, 95% CI: 0.56, 1.35; p = 0.53) between the ambulatory and SLD groups. There were fewer >3 Clavien-Dindo complications in the ambulatory group (RR: 0.34, 95% CI: 0.19, 0.59; p = 0.0002). Few studies reported average health care cost and patient satisfaction. Conclusions: In appropriately selected patients, ambulatory MIPN is safe and feasible. Future studies are needed to quantify cost and patient satisfaction differences and further identify appropriate patient selection criteria for ambulatory MIPN.

Purpose: The study's aim was to externally validate a new predictive model for the new baseline glomerular filtration rate (NB-GFR) postnephrectomy among Japanese patients. Materials and Methods: Patients with renal tumors who underwent radical nephrectomy (RN) or robot-assisted laparoscopic partial nephrectomy (PN) at a single Japanese institution during the period 2000–2020 were retrospectively analyzed. The NB-GFR is defined as the final estimated glomerular filtration rate within postoperative 3–12 months. The correlation/bias/accuracy/precision of the equation was examined by comparing the calculated NB-GFR with the observed rate. Results: The study included 485 cases of RN and 1030 cases of robot-assisted laparoscopic PN. The correlation/bias/accuracy/precision of the new equation predicting the NB-GFR was 0.86/−0.92/95.9/−5.65–3.62 in robot-assisted laparoscopic PN and 0.79/−1.02/87.8/−6.26–3.91 in RN, respectively. The fractional polynomial regression line approximated zero and its pointwise 95% confidence interval (CI) was considerably tight for the majority of both cohorts. The 95% CI to discriminate NB-GFRs ≥45 mL/min/1.73 m2 from receiver operating curves was 0.96 (0.95–0.97) and 0.89 (0.87–0.92) in robot-assisted laparoscopic PN and RN, respectively. Various preoperative factors, including age, tumor size, complexity, body mass index, hypertension, and diabetes, did not affect the predictive ability (correlation >0.7) of the subgroup analysis. Conclusion: The novel simple equation can accurately predict NB-GFRs after radical and robot-assisted laparoscopic partial nephrectomies in Japanese patients. This model will help physicians choose surgical treatments for renal tumors in daily clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the utility of radiomics features of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate fat-poor angiomyolipoma (fpAML) from clear cell renal cell carcinoma (ccRCC). Materials and methods: This multi-institutional study included two cohorts with pathologically confirmed renal tumors: 65 patients with ccRCC and 18 with fpAML in the model development cohort, and 17 with ccRCC and 13 with fpAML in the external validation cohort. All patients underwent magnetic resonance imaging (MRI) including DW-MRI. Radiomics analysis was used to extract 39 imaging features from the apparent diffusion coefficient (ADC) map. The radiomics features were analyzed with unsupervised hierarchical cluster analysis. A random forest (RF) model was used to identify radiomics features important for differentiating fpAML from ccRCC in the development cohort. The diagnostic performance of the RF model was evaluated in the development and validation cohorts. Results: The cases in the developmental cohort were classified into three groups with different frequencies of fpAML by cluster analysis of radiomics features. RF analysis of the development cohort showed that the mean ADC value was important for differentiating fpAML from ccRCC, as well as higher-texture features including gray-level run length matrix (GLRLM)_long-run low gray-level enhancement (LRLGE), and GLRLM_low gray-level run emphasis (LGRE). The area under the curve values of the development [0.90, 95% confidence interval (CI) 0.80–1.00] and validation cohorts (0.87, 95% CI 0.74–1.00) were similar (P = 0.91). Conclusion: The radiomics features of ADC maps are useful for differentiating fpAML from ccRCC. [ABSTRACT FROM AUTHOR]

Abstract Background Cancer patients incur high care costs; however, there is a paucity of literature characterizing unmet financial obligations for patients with urologic cancers. Kidney cancer patients are particularly burdened by costs associated with novel systemic treatments. This study aimed to ascertain the characteristics of GoFundMe® crowdfunding campaigns for patients with kidney cancer, in order to better understand the financial needs of this population. Methods We performed a cross‐sectional, quantitative, and qualitative analysis of all kidney cancer GoFundMe® campaigns since 2010. Fundraising metrics such as goal funds and amount raised, were extracted. Eight independent investigators collected patient, disease and campaign‐level variables from campaign stories (κ = 0.72). In addition, we performed a content analysis of campaign narratives spotlighting the primary appeal of the patient's life story. Results A total of 486 GoFundMe® kidney cancer campaigns were reviewed. The median goal funds were 10,000USD [IQR = 5000, 20,000] and the median amount raised was 1450USD [IQR = 578, 4050]. Most campaigns were for adult males (53%) and 62% of adults had children. A minority were for pediatric patients (17%). Thirty‐seven percent of adult patients were primary wage earners and 43% reported losing their job or substantially reducing hours due to illness. Twenty‐nine percent reported no insurance or insufficient coverage. Campaigns most frequently sought funds for medical bills (60%), nonmedical bills (27%), and medical travel (23%). Qualitative campaign narratives mostly emphasized patients’ hardship (46.3%) or high moral character (35.2%). Only 8% of campaigns achieved their target funds. Conclusions Despite fundraising efforts, patients with kidney cancer face persistent financial barriers, incurring both medical and nonmedical cost burdens. This may be compounded by limited or no insurance. Cancer care providers should be aware of financial constraints placed on kidney cancer patients, and consider how these may impact treatment regimens.

BackgroundBeyond age and comorbidity, functionality can shape the long-term survival potential of patients with cancer. Accordingly, herein the authors compared mortality and receipt of cancer-directed surgery according to patient function among older adults with kidney cancer.MethodsUsing Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 through 2009, the authors studied 28,326 elderly subjects with primary kidney cancer. Patient function was quantified using function-related indicators, claims indicative of dysfunction and disability. Adjusting for patient and cancer characteristics, competing risk regression was used to assess the relationship between function-related indicator count and cause-specific mortality and then generalized estimating equations were used to quantify the probability of surgery.ResultsA total of 13,619 adult patients (48.1%) with at least 1 function-related indicator were identified. A higher indicator category was associated with older age, greater comorbidity, female sex, unmarried status, lower socioeconomic status, and higher stage of disease (P

Significant progress has been made in the management of Wilms tumor (WT) in recent years, mostly as a result of collaborative efforts and the implementation of protocol-driven, multimodal therapy. This article offers a comprehensive overview of current multidisciplinary treatment strategies for WT, whilst also addressing recent technical innovations including nephron-sparing surgery (NSS) and minimally invasive approaches. In addition, surgical concepts for the treatment of metastatic disease, advances in tumor imaging technology and potentially prognostic biomarkers will be discussed. Current evidence suggests that, in experienced hands and selected cases, laparoscopic radical nephrectomy and laparoscopic-assisted partial nephrectomy for WT may offer the same outcome as the traditional open approach. While NSS is the standard procedure for bilateral WT, NSS has evolved as an alternative technique in patients with smaller unilateral WT and in cases with imminent renal failure. Metastatic disease of the lung or liver that is associated with WT is preferably treated with a three-drug chemotherapy and local radiation therapy. However, surgical sampling of lung nodules may be advisable in persistent nodules before whole lung irradiation is commenced. Several tumor markers such as loss of heterozygosity of chromosomes 1p/16q, 11p15 and gain of function at 1q are associated with an increased risk of recurrence or a decreased risk of overall survival in patients with WT. In summary, complete resection with tumor-free margins remains the primary surgical aim in WT, while NSS and minimally invasive approaches are only suitable in a subset of patients with smaller WT and low-risk disease. In the future, advances in tumor imaging technology may assist the surgeon in defining surgical resection margins and additional biomarkers may emerge as targets for development of new diagnostic tests and potential therapies.

To evaluate relationship between histological subtypes of renal cell carcinoma (RCC) and preoperative c-reactive protein (CRP). We queried the International Marker Consortium for Renal Cancer database for patients affected by RCC. Patients were classified according to their histology: benign tumors, clear cell (cc) RCC, chromophobe (ch) RCC, papillary (p) RCC, and variant histology (vh) RCC; and according to CRP (mg/L): low CRP ≤5 and high CRP >5. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM), recurrence and association between CRP and histology. Multivariable analysis (MVA) via Cox regression and multivariable logistic regression were fitted to elucidate predictors of outcomes. Total 3902 patients (high CRP n = 1266) were analyzed; median follow up 51 (IQR 20-91) months. On MVA elevated CRP was an independent risk factor associated with increased risk of ACM in benign tumors (HR 5.98, P <.001), ccRCC (HR 2.69, P <.001), chRCC (HR 3.99, P <.001), pRCC (HR 1.76, P =.009) and vhRCC (HR 2.97, P =.007). MVA for CSM showed CRP as risk factor in ccRCC (HR 2.77, P <.001), chRCC (HR 6.16, P =.003) and pRCC (HR 2.29, P =.011), while in vhRCC was not (P =.27). MVA for recurrence reported CRP as risk factor for ccRCC (HR 1.30, P =.013), while in chRCC (P =.33), pRCC (P =.34) and vhRCC (P =.52) was not. On multivariable logistic regression CRP was a predictor of pRCC (OR 1.003, P =.002), while decreasing CRP was associated with benign tumors (OR 0.994, P =.048). Elevated CRP was a robust predictor of worsened ACM in all renal cortical neoplasms. While most frequently observed in pRCC patients, elevated CRP was independently associated with worsened CSM in non-vhRCC. Conversely, elevated CRP was least likely to be noted in benign tumors, and elevation in this subgroup of patients should prompt further consideration for surveillance given increased risk of ACM. Further investigation is requisite. We examined the relationship between presurgical c-reactive protein levels and oncological outcomes across various renal cell carcinoma types in a group of 3902 individuals, and we observed that elevated c-reactive protein (>5.0 mg/L) was consistently linked to overall mortality in all renal cortical tumors, and cancer specific mortality in non-variant histology renal cell carcinoma. [ABSTRACT FROM AUTHOR]

Objective: The experience of performing robot-assisted partial nephrectomy (RAPN) is associated with better surgical outcomes. However, surgeon's generation may impact surgical outcomes. We evaluated the perioperative outcomes of RAPN between first- and second-generation surgeons according to the surgeon's experience.Methods: This study included 529 patients who underwent RAPN for renal cell carcinoma from January 2013 to November 2018. Four specific surgeons performed the surgery. According to the surgeon's generation, the patients were divided into two groups: first-generation and second-generation. To reflect the learning curve of RAPN, the surgical outcomes of each case (1-50, 51-100, 101-150) were evaluated between these groups.Results: Between 1 to 50 cases and 101-150 cases, no significant differences in patient characteristics were observed between the two generations. Between 51-100 cases, age at surgery was significantly younger in the first-generation than in the second-generation group (58 years vs. 64 years, p = 0.04). The second-generation group had a shorter operation time in cases 1-50 (169 min vs. 188 min, p = 0.0001), 51-100 (145 min vs. 169 min, p = 0.008), and 101-150 (142 min vs. 165 min, p = 0.009), than the first-generation group. Although shorter WIT and higher trifecta achievement were observed in the second-generation group than in the first-generation group between 1-50 cases, the difference was not noted between 51-100 cases and 101-150 cases.Conclusion: Patients operated by second-generation surgeons had better surgical outcomes than first-generation surgeons, especially during the early experience period, which might result from their assistance experience, sophisticated surgical procedures refined by the first-generation, and the first-generation surgeon's introduction. [ABSTRACT FROM AUTHOR]

Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation is a very extremely rare tumor and only few cases have been reported in the literature. Here we report a case of a 37-year-old woman who presented with a pain and a palpable mass in the right flank. The abdominal computed tomography (CT) scan found a renal tumor and the patient underwent a right radical nephrectomy with adrenal gland resection. After the histological examination of the specimen completed by immunohistochemical and molecular study, a diagnosis of chromophobe renal cell carcinoma with liposarcomatous dedifferentiation was made. The patient received adjuvant chemotherapy. Afterwards, she developed bone metastasis and died 13 months after the surgery. Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation is a rare tumor associated with a poor prognosis and a metastatic potential. [ABSTRACT FROM AUTHOR]

Objective: To assess the safety and oncological outcomes of Open Partial Nephrectomy in management of small renal tumours. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2015 to Dec 2018. Methodology: We prospectively studied 61 patients with renal tumours either observed on computerized tomography (CT) scan or magnetic resonance imaging (MRI) having size ≤7cm and underwent open partial nephrectomy. The collected data included demographics, dimension of tumour, indication for surgery, cold ischemia time, hospital stay, complications and histopathological finding including involvement of margins. Patients were followed up for atleast 2 years. Results: Among 61, 39 patients were male and 22 females. The age of patients ranged from 20-72 years. Mean cold ischaemia time was 24.7 ± 6.37 minutes. Except for 2 patients with Von Hippel–Lindau (VHL) disease, all other patients had solitary renal growth. Nine (14.75%) patients had solitary kidney. The mean of maximum dimension of tumours was 3.84 ± 1.38 cm and mean hospital stay was 3.18 ± 2.19 days. Histopathological results showed 34 tumours to be conventional renal cell carcinoma (RCC) (55.73%) followed by 12 papillary renal cell carcinoma (19.67%). Two (3.27%) patients had positive surgical margin who were operated for >5 cm tumours and later managed expectantly. Twenty one patients had Grade I and II complications while 2 patients were stented post operatively for urine leak. At 2 years follow up there was no recurrence of tumour in any of the patient operated. Conclusion: Open ..........

Aim determination of the most informative combination of biomarker tests and modern methods of radiological diagnosis of kidney tumors in clinical practice. Material and methods. The study included clinical and morphological data of 133 patients with kidney tumors. In order to identify the informative markers of kidney tumors, such indicators as gender, age; CT and ultrasound imaging results; vascularization, density, tumor contrast, histological examination, levels of tumor pyruvate kinase and vascular endothelial growth factor were analyzed. The results were statistically processed using Statistica 10 and SAS JMP 11 software. Results. Determination of biomarkers showed a significant increase in the level of tumor pyruvate kinase and vascular endothelial growth factor in the group of patients with kidney cancer. The TuPKM2 level in these patients reached 46.3 27.2 u/l, and in the group with benign tumors 27.8 16.4 u/l, the VEGF indices were 330.0 42.91 pg/ml and 266.3 26.39 pg/ml, respectively (p 0.05). The analysis of CT results showed that in the group of patients with kidney cancer, hypervascular mass was diagnosed much more often than in the group with benign tumors (69.5% and 26.7%, respectively) (p 0.05). Vascularization is associated with the histology of neoplasms. The nature of contrast and density, determined using CT, are interrelated. The ROC analysis revealed that the most important variables for the diagnosis of kidney cancer are vascularization (relative risk = 1.24) and an increase in TuPKM2 levels above 15 u/l (relative risk = 1.24). Conclusion. The study results revealed TuPKM2 and the nature of tumor vascularization to be the key markers for the diagnosis of kidney cancer. The groups of patients with different neoplasms had statistically significant difference in terms of TuPKM2 and VEGF. In clinical practice, a comprehensive study for kidney tumor diagnosis is rational, including the determination of tumor pyruvate kinase in combination with ultrasound examination of the kidneys and computed tomography.

Resumen: Objetivo: Evaluar la asociación entre la exposición al radón y el cáncer genitourinario en población minera a través de una revisión sistemática de la literatura científica. Método: Se realizó una revisión sistemática de la literatura científica en MEDLINE (PubMed) combinando términos MeSH (Medical Subject Heading) y términos libres. Se realizó una escala específica de valoración de la calidad de los estudios incluidos. Resultados: Se incluyeron 17 estudios. Todos fueron estudios de cohortes, excepto uno que fue un pool de datos. Todos los estudios incluían análisis de la relación entre la exposición al radón y el cáncer genitourinario. Los resultados son ambiguos: unos estudios apuntan hacia una asociación entre la exposición y el cáncer genitourinario, especialmente de riñón, y otros no encuentran asociación. Conclusión: Los estudios incluidos presentan una gran heterogeneidad metodológica. No puede concluirse que exista una asociación entre la exposición al radón y el cáncer genitourinario. Es necesaria más investigación sobre el tema, con estudios que tengan más potencia estadística y mejor control de las variables confusoras, y preferentemente que sean prospectivos. Abstract: Objective: To assess the association between exposure to radon and genitourinary cancer in a mining population through a systematic review of the scientific literature. Method: A systematic review of the scientific literature was carried out in MEDLINE (PubMed), combining MeSH (Medical Subject Heading) terms and free terms. We applied a specific scale to assess the quality of the included studies. Results: We included 17 studies; all were cohort studies with the exception of one which was a pooling of data. All studies included analysed the relationship between exposure to radon and genitourinary cancer. While some studies point towards an association between radon exposure and genitourinary cancer, especially kidney cancer, others do not find such association. Conclusions: The included studies showed great heterogeneity. It cannot be concluded that there is an association between exposure to radon and genitourinary cancer. More research is needed on this topic, designing studies with higher statistical power, better control of confounders, and preferably prospective.

Purpose: Does surgical approach (minimally invasive vs. open) and type (radical vs. partial nephrectomy) affects opioid use and workplace absenteeism. Materials and Methods: Retrospective multivariable regression analysis of 2,646 opioid-naïve patients between 18 and 64 undergoing radical or partial nephrectomy via either a minimally invasive vs. open approach for kidney cancer in the United States between 2012 and 2017 drawn from the IBM Watson Health Database was performed. Outcomes included: (1) opioid use in opioid-naïve patients as measured by opioid prescriptions in the post-operative setting at early, intermediate and prolonged time periods and (2) workplace absenteeism after surgery. Results: Patients undergoing minimally invasive surgery had a lower odds of opioid use in the early and intermediate post-operative periods (early: odds ratio [OR], 0.77; 95% confidence interval [CI], 0.62–0.97; p=0.02, intermediate: OR, 0.60; 95% CI, 0.48–0.75; p

Objective A systematic review of clinical trials on thermal ablation of T1b RCC was conducted to assess oncologic outcomes of those procedures. The primary endpoint was the rate of local recurrence. Secondary endpoints included technical efficacy, progression to metastatic disease, cancer-specific mortality, complications and renal function decrease. Methods PubMed (MEDLINE) and Embase databases were searched in June 2020 for eligible trials following the PRISMA selection process. Prevalence of local recurrence and per procedural major adverse effects were calculated using double arcsine transformation and a random-effects model. Results Nine clinical trials (all retrospective) involving 288 patients with T1b renal clear cell carcinoma treated with either percutaneous microwave ablation, cryoablation or radiofrequency ablation were analyzed. Using a random-effects model, the overall prevalence of local recurrence following percutaneous ablation was 0.08 (0.04–0.14; p = 0.05). Primary technical efficacy was 226/263 (86%) patients and secondary technical efficacy was 247/263 (94%). Overall, 10/176 (6%) patients presented metastatic locations following the ablation. Major adverse effects prevalence was 0.09 (0.06–0.14; p = 0.05). Conclusions Thermal ablations are feasible, safe, and effective to treat T1b renal clear cell carcinoma. More trials are necessary to determine the rate of the evidence of the benefit.Highlights Thermal ablations are feasible and safe to treat T1b renal clear cell carcinoma. Oncologic outcomes appear to be very good on both local control and distant progression. Due to small number and heterogeneity of studies more trials are necessary to determine the rate of the evidence of the benefit.

To report our preliminary results of thermal ablation, including microwave and radiofrequency ablation assisted laparoscopic partial nephrectomy for cT1b renal tumors. A total of 56 patients with cT1b renal tumors who underwent microwave ablation or radiofrequency ablation assisted laparoscopic partial nephrectomy between January 2014 and May 2018 were enrolled. Thirty of them underwent microwave ablation assisted laparoscopic partial nephrectomy (MWA-LPN group), and the other 26 received radiofrequency ablation assisted laparoscopic partial nephrectomy (RFA-LPN group). Baseline, perioperative and follow-up data were compared between the two groups. There were no statistical differences with respect to patients' gender, age, tumor size, RENAL score, BMI and estimated glomerular filtration rate between the MWA-LPN and RFA-LPN group, nor were any differences observed in warm ischemia time, post-operative complications and hospital stay. Patients in the MWA-LPN group had shorter median operative time (p =.012), less estimated blood loss (p =.023). Median follow-up was 36 months (range 12–64). Three-year cancer-specific and progression-free survival was 100% and 96.4%. The overall kidney recurrence rate was 3.6% in the present study. Thermal ablation assisted laparoscopic partial nephrectomy is a safe, effective nephron-sparing treatment which provides acceptable results for selective cT1b renal tumors. [ABSTRACT FROM AUTHOR]

Background: Lymphoma is a malignant lymphoid tumor originating in the lymph nodes or other solid organs and comprises 90% of all hematopoietic tumors in dogs. However, primary kidney lymphoma is rare and is associated with nonspecific clinical signs. Tumor invasion in both kidneys can cause severe clinical signs due to renal failure, complicating the patient’s treatment and prognosis. The aim of this case was to report the case of a dog affected by bilateral primary kidney lymphoma. In addition, to characterize the clinical and histopathological presentation due to the intense morphological changes. Case: A 5-year-old male Poodle dog was admitted showing apathy and emesis for 5 days. On physical examination, the dog showed 10% of dehydration, reddish oral mucous membranes, poor body condition (score 1/5), uremic breath, and pain in the kidney area. Complementary tests revealed severe low white blood cells count, high BUN levels, high levels of potassium, calcium, and phosphorus (serum biochemistry). Abdominal ultrasound showed bilateral kidney enlargement. Fine needle aspiration of the mass (guided by ultrasound) revealed round cell tumor. Radiographs showed no alterations. The dog died due to his poor condition and necropsy was performed. On post-mortem examination, the kidneys were both enlarged, pale, and with an irregular subcapsular surface. The histopathological diagnostic was primary renal lymphoma. Immunohistochemical staining revealed that neoplastic cells were strongly positive for anti CD20 and PAX5, while negative for CD3, supporting the diagnosis of B-cell lymphoma. Discussion: The diagnosis was based on clinical, complementary tests, fine needle aspiration, histopathological and immunohistochemical findings. In dogs, primary kidney tumors are uncommon and usually malignant. The presence of vomiting, uremic breath, dehydration, weight loss, and erosive and ulcerative lesions on the tongue (uremic glossitis) are clinical signs of chronic renal failure, and this condition was later confirmed by laboratory tests and histopathological findings. Dogs diagnosed with extra-nodal renal lymphoma, present clinical signs such as polydipsia, polyuria, vomiting, and uremic breath in some cases. These changes are compatible with changes observed in cases of renal failure. In this case, the severe azotemia, hyperphosphatemia, hypocalcemia, and hyperkalemia were due to the neoplastic infiltration in both kidneys. Additionally, the abdominal ultrasound revealed the tumor in both kidneys. Almost 38% of dogs with renal lymphoma presented in urine evaluation normal urine density and a large amount of protein in the urine, similar to those observed in this dog. When the lesions are on both kidneys, kidney failure develops and uremic extra-renal lesions appear, as observed in this case. The prevalence of primary kidney tumors in domestic animals corresponds to less than 1% of the total of the tumors reported, and they are usually in one kidney. In dogs, almost 60 - 70% of lymphomas are B cells, 30 - 40% are T cells, and less than 1% are null cells. B-cell lymphomas usually show less aggressive behavior when compared to T-cell lymphomas. Kidney lymphoma can be included as an important cause of kidney failure, and has slow and progressive development, making early diagnosis and treatment difficult. [ABSTRACT FROM AUTHOR]

Introduction: Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index. Methods: The cohort was derived from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction, stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer–Lemeshow test and compared to the RCRI and the AUB-HAS2 index. Results: In a cohort of 4795 patients, MACE occurred in 52 (1.1%) patients. A univariate analysis yielded 13 eligible variables for entry into the multivariate model. The final PN-A4CH model utilized six variables: A ge ⩾75 years, A SA class >2, A nemia, surgical A pproach, C reatinine >1.5, and history of H eart disease. Index ROC analysis provided a C-statistic of 0.81, calibration R 2 was 0.99, and sensitivity was 85%. In comparison, the RCRI and AUB-HAS2 C-statistics were 0.59 and 0.68, respectively. Conclusion: This study proposes a novel procedure-specific cardiovascular risk index. The PN-A4CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection. [ABSTRACT FROM AUTHOR]

Objective: Robot-assisted laparoscopic partial nephrectomy (RAPN) for completely endophytic renal tumors is challenging because of the tumor complexity. The enucleation technique is an ideal resection method to maximally preserve the renal parenchyma. In the present study, we investigated the surgical outcomes of RAPN for completely endophytic renal tumors and compared them between the enucleation and standard resection techniques. Methods: One hundred and forty-four patients who underwent RAPN for completely endophytic tumors were the subjects of this study. The subjects were divided into two groups according to the Surface-Intermediate-Base margin score (SIB score): the enucleation group (SIB score 0–2) and the standard resection group (SIB score 3–5). To minimize selection bias between the two surgical methods, patient variables such as age, sex, body mass index, American Society of Anesthesiologists score, tumor size, RENAL nephrometry score (RENAL NS), and preoperative renal function were adjusted using 1:1 propensity score matching. Results: Of the 144 patients, 72 were assigned to the enucleation group and 72 to the standard resection group. After matching, 45 patients were included in each group. The mean tumor size was 26–27 mm and the mean RENAL NS was 9.0–9.1, after matching. The enucleation group showed significantly better preservation of the estimated glomerular filtration rate in the early postoperative period (−4.9% vs −16%, p = 0.0005) and at 6–12 months after surgery (−4.9% vs −9.2%, p = 0.0327) than the standard resection group. In addition, a shorter operation time (140 vs 167 minutes, p = 0.0028) was observed in the enucleation group. Other outcomes, including estimated blood loss, positive surgical margin rate, incidence rate of complications, and length of hospital stay, were not significantly different between the two groups. Conclusion: The enucleation technique showed better surgical outcomes for completely endophytic renal tumors in terms of preservation of renal function and operation time than the standard resection technique. [ABSTRACT FROM AUTHOR]