Robot-assisted surgery in horseshoe kidneys: A safety and feasibility multi-centre case series

OBJECTIVE: We assessed the safety and feasibility of minimally invasive robot-assisted surgery for horseshoe kidney (HSK). METHOD: A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020. RESULTS: A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020. CONCLUSION: We report one the largest series of robot-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in centralised high-volume centres with acceptable perioperative outcomes. Established benefits of minimally invasive surgery, such as reduced LOS and low complication rates, were demonstrated. LEVEL OF EVIDENCE: 4

Growth and renal function dynamics of renal oncocytomas on active surveillance

OBJECTIVES: To study the natural history of renal oncocytomas and address indications for intervention by determining how growth is associated with renal function over time, the reasons for surgery and ablation, and disease-specific survival. PATIENTS AND METHODS: The study was conducted in a retrospective cohort of consecutive patients with renal oncocytoma on active surveillance reviewed at the Specialist Centre for Kidney Cancer at the Royal Free London NHS Foundation Trust (2012 to 2019). Comparison between groups was performed using Mann–Whitney U-tests and chi-squared tests. A mixed-effects model with a random intercept for patient was used to study the longitudinal association between tumour size and estimated glomerular filtration rate (eGFR). RESULTS: Longitudinal data from 98 patients with 101 lesions were analysed. Most patients were men (68.3%) and the median (interquartile range [IQR]) age was 69 (13) years. The median (IQR) follow-up was 29 (26) months. Most lesions were small renal masses, and 24% measured over 4 cm. Over half (64.4%) grew at a median (IQR) rate of 2 (4) mm per year. No association was observed between tumour size and eGFR over time (P = 0.871). Nine lesions (8.9%) were subsequently treated. Two deaths were reported, neither were related to the diagnosis of renal oncocytoma. CONCLUSION: Natural history data from the largest active surveillance cohort of renal oncocytomas to date show that renal function does not seem to be negatively impacted by growing oncocytomas, and confirms clinical outcomes are excellent after a median follow-up of over 2 years. Active surveillance should be considered the 'gold standard' management of renal oncocytomas up to 7cm

Volume-outcome relationship in penile cancer treatment: a population based patterns of care and outcomes study from Australia

Abstract Objectives To study the patterns of care of penile cancer diagnosed in the state of New South Wales (NSW) over a 10 year period and determine factors that are associated with differences in survival. Patients and Methods All invasive penile cancer diagnosed between 2001 and 2009 in NSW, Australia, were identified from the Central Cancer Registry. Records of treatment from the Admitted Patient Data Collection and deaths from the Registry of Births Deaths and Marriages were electronically linked. Predictors of receiving an inguinal lymph node dissection (ILND) were analysed using multivariable logistic regression. Survival analyses were performed with Kaplan-Meier and Cox proportional hazards models. Results A total of 220 men were diagnosed with penile cancer over the 10 years from 69 centres. The median number of penile operations performed over 10 years was <4. Radical penile surgery (partial or total penectomy) was performed in 70% of the cases and the proportion of patients receiving radical surgery increased over time (P = 0.015). Only 53/220 men with invasive penile cancer received an ILND. Younger age and higher stage were the only factors that predicted whether ILND was performed. Overall survival (OS) was predicted by age, stage, marital status and co-morbidity status. Low centre volume decreased OS by 37% (HR 0.63 [95% CI: 0.40–0.97]). For men who received ILND, low centre volume decreased OS by 60% (HR 0.40 [95% CI: 0.19–0.85]). Conclusions There is a decreasing trend for the use of conservative penile surgery and median centre volumes for penile cancer surgery in NSW are low. A decrease in overall survival is observed in men treated in lower volume surgery centres