Eduard Roussel1, Giovanni Tasso2, Riccardo Campi2, Maximilian C Kriegmair3, Önder Kara4, Tobias Klatte5, Umberto Capitanio6, Riccardo Bertolo7, Alexandre Ingels8, Selcuk Erdem9, Loïc Baekelandt1, Maria C Mir10, Idir Ouzaid11, Nicola Pavan12, Benoit Beuselinck13, Mauro Gacci2, Andrea Minervini2, Alessandro Volpe14, Maarten Albersen15. 1. Department of Urology, University Hospitals Leuven, Leuven, Belgium. 2. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 3. Department of Urology, University Medical Centre Mannheim, Mannheim, Germany. 4. Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey. 5. Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK; Department of Surgery, University of Cambridge, Cambridge, UK. 6. Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 7. Department of Urology, San Carlo di Nancy Hospital, Rome, Italy. 8. Department of Urology, University Hospital Henri Mondor, APHP, UPEC, Créteil, France. 9. Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey. 10. Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain. 11. Department of Urology, Bichat Claude Bernard Hospital, Paris, France. 12. Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy. 13. Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium. 14. Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy. 15. Department of Urology, University Hospitals Leuven, Leuven, Belgium. Electronic address: maarten.albersen@uzleuven.be.
Abstract
BACKGROUND: Despite being the most frequent renal fusion anomaly, tumors arising from horseshoe kidneys (HSKs) are extremely rare and management guidance is lacking. OBJECTIVE: To evaluate the perioperative, oncological, and functional outcomes of surgically treated HSK tumors. DESIGN, SETTING, AND PARTICIPANTS: A retrospective, multicenter cohort study of 43 HSK tumors in 40 patients was conducted, and technical description of the surgical approach has been provided. SURGICAL PROCEDURE: Surgical resection of renal tumors arising from HSKs was performed either via open surgery or via minimally invasive surgery (MIS). MEASUREMENTS: We analyzed patient and tumor characteristics as well as surgical technique, and functional and oncological outcomes. RESULTS AND LIMITATIONS: Eight patients were treated by MIS and 32 by open surgery. One patient (2.5%) experienced an intraoperative complication and 13 patients (32.5%) experienced postoperative complications, of which three (7.5%) were Clavien-Dindo ≥3 complications. Surgical margins were positive in two tumors (4.7%). The most frequent histology was clear-cell renal cell carcinoma (46.5%). The median follow-up was 51 (interquartile range [IQR] 17-73) mo. The 5-yr overall, cancer-specific, and recurrence-free survival rates were 81.2%, 86.8%, and 83.1%, respectively. The percent decreases in estimated glomerular filtration rate at discharge and the last follow-up were 15% (IQR 4-26%) and 17% (IQR 1-31%), respectively. Limitations include the cohort's retrospective nature, heterogeneity, and small sample size. CONCLUSIONS: Surgical management of tumors in HSKs can be approached via both open surgery and MIS, with maximal preservation of functional renal parenchyma. In this cohort, rates of complications, positive surgical margins, and renal functional decrease were acceptable, considering the anatomical complexity of these kidneys and tumors. These tumors display great variation in histological subtypes. Meticulous presurgical planning, taking advantage of advanced imaging techniques, can aid in achieving good outcomes. PATIENT SUMMARY: We evaluated the surgical management of renal tumors in horseshoe kidneys, which are very rare. Although these procedures are highly complex, outcomes are acceptable. Modern imaging techniques are often required in presurgical planning.
BACKGROUND: Despite being the most frequent renal fusion anomaly, tumors arising from horseshoe kidneys (HSKs) are extremely rare and management guidance is lacking. OBJECTIVE: To evaluate the perioperative, oncological, and functional outcomes of surgically treated HSK tumors. DESIGN, SETTING, AND PARTICIPANTS: A retrospective, multicenter cohort study of 43 HSK tumors in 40 patients was conducted, and technical description of the surgical approach has been provided. SURGICAL PROCEDURE: Surgical resection of renal tumors arising from HSKs was performed either via open surgery or via minimally invasive surgery (MIS). MEASUREMENTS: We analyzed patient and tumor characteristics as well as surgical technique, and functional and oncological outcomes. RESULTS AND LIMITATIONS: Eight patients were treated by MIS and 32 by open surgery. One patient (2.5%) experienced an intraoperative complication and 13 patients (32.5%) experienced postoperative complications, of which three (7.5%) were Clavien-Dindo ≥3 complications. Surgical margins were positive in two tumors (4.7%). The most frequent histology was clear-cell renal cell carcinoma (46.5%). The median follow-up was 51 (interquartile range [IQR] 17-73) mo. The 5-yr overall, cancer-specific, and recurrence-free survival rates were 81.2%, 86.8%, and 83.1%, respectively. The percent decreases in estimated glomerular filtration rate at discharge and the last follow-up were 15% (IQR 4-26%) and 17% (IQR 1-31%), respectively. Limitations include the cohort's retrospective nature, heterogeneity, and small sample size. CONCLUSIONS: Surgical management of tumors in HSKs can be approached via both open surgery and MIS, with maximal preservation of functional renal parenchyma. In this cohort, rates of complications, positive surgical margins, and renal functional decrease were acceptable, considering the anatomical complexity of these kidneys and tumors. These tumors display great variation in histological subtypes. Meticulous presurgical planning, taking advantage of advanced imaging techniques, can aid in achieving good outcomes. PATIENT SUMMARY: We evaluated the surgical management of renal tumors in horseshoe kidneys, which are very rare. Although these procedures are highly complex, outcomes are acceptable. Modern imaging techniques are often required in presurgical planning.