Renal cell carcinomas mass of <4 cm are not always indolent

Context: The rate of progression to metastatic disease in patients undergoing active surveillance for small renal tumors varies in the literature between 1% and 8%. Aims: This study aims to examine the incidence of metastasis in small renal tumors of <4 cm in a Danish cohort. Settings and Design: Retrospective. Methods and Material: Data on 106 patients who were diagnosed with renal cancer (RCC) of <4 cm by CT scan from January 2005 to December 2013 were collected retrospectively in January 2016 from patient charts and analyzed. Statistical Analysis Used: The cancer-specific survival (CSS) and overall survival (OS) were estimated using Kaplan-Meier methods. Results: The mean age was 62 years (range 40–84 years). Two patients (1.9%) had metastases at the time of diagnosis. Radical nephrectomy was performed in 74 patients (70%); of them, one patients (1.4%) experienced late metastasis (LM). Partial nephrectomy was performed in 30 patients (28%); of them, two patients (6.7%) experienced LM. The mean time to LM was 27 ± 12 months (95% confidence interval: 4–56). CSS rates were 98%, 97%, and 97% for 1, 3, and 5 years, respectively, while OS rates were 96%, 92%, and 86% for 1, 3, and 5 years, respectively. On multivariate analysis, tumor size (P = 0.04), pT3a (P = 0.0017), and patient's age (P = 0.02) at the time of diagnosis were significant predictors of LM. Conclusions: Even small renal carcinomas may be aggressive, and caution should be taken when offering active surveillance

Incidence and associated risk factors of venous thromboembolism after open and laparoscopic partial nephrectomy in patients administered short-period thromboprophylaxis : a Danish nationwide population-based cohort study

Objective: To report the risk of venous thromboembolism (VTE) after partial nephrectomy in Denmark. Materials and methods: A nationwide population-based registry was used to conduct a retrospective cohort study. All partial nephrectomies from January 2010 to August 2018 were assessed for postoperative VTE events. Univariable and multivariable analyses were used to evaluate the odds of postoperative VTE within 4 weeks and 4 months after partial nephrectomy in patients who received standard-of-care thromboprophylaxis. Results: Among 2355 patients, postoperative VTE risk was 0.6% and 0.9%, at 4 weeks and 4 months, respectively. In multivariate analysis, prior VTE (OR = 24.9, p < 0.001) and length of hospital stay (OR = 0.89, p < 0.001) were predictors of postoperative VTE within 4 months after partial nephrectomy. Limitations included the retrospective and registry-based study design and the absence of BMI data. Conclusion: Incidence of postoperative VTE is rare, but patients with prior VTE and those with a greater length of hospital stay are at greater long-term risk and should be evaluated when considering thromboprophylaxis