Department of Urology, University Hospitals Leuven, Leuven, Belgium.
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Eur Urol. 2021 Jan;79(1):133-140. doi: 10.1016/j.eururo.2020.09.012. Epub 2020 Sep 16.
Despite being the most frequent renal fusion anomaly, tumors arising from horseshoe kidneys (HSKs) are extremely rare and management guidance is lacking.
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 resection of renal tumors arising from HSKs was performed either via open surgery or via minimally invasive surgery (MIS).
We analyzed patient and tumor characteristics as well as surgical technique, and functional and oncological outcomes.
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.
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.
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.
尽管马蹄肾（HSK）是最常见的肾脏融合异常，但源自马蹄肾的肿瘤极为罕见，缺乏管理指导。
评估手术治疗马蹄肾肿瘤的围手术期、肿瘤学和功能结果。
设计、地点和参与者：对 40 名患者的 43 个 HSK 肿瘤进行了回顾性多中心队列研究，并提供了手术入路的技术描述。
通过开放手术或微创外科手术（MIS）对源自 HSK 的肾肿瘤进行手术切除。
我们分析了患者和肿瘤特征以及手术技术以及功能和肿瘤学结果。
8 名患者接受了 MIS 治疗，32 名患者接受了开放手术治疗。1 名患者（2.5%）发生术中并发症，13 名患者（32.5%）发生术后并发症，其中 3 名（7.5%）为 Clavien-Dindo ≥3 级并发症。2 个肿瘤（4.7%）的手术切缘阳性。最常见的组织学类型是透明细胞肾细胞癌（46.5%）。中位随访时间为 51 个月（四分位距 [IQR] 17-73）。5 年总生存率、癌症特异性生存率和无复发生存率分别为 81.2%、86.8%和 83.1%。出院时和最后一次随访时估计肾小球滤过率的百分比下降分别为 15%（IQR 4-26%）和 17%（IQR 1-31%）。局限性包括队列的回顾性、异质性和样本量小。
HSK 中肿瘤的手术治疗可以通过开放手术和 MIS 两种方法进行，同时最大限度地保留功能性肾实质。在本队列中，考虑到这些肾脏和肿瘤的解剖复杂性，并发症、手术切缘阳性和肾功能下降的发生率可以接受。这些肿瘤在组织学亚型上存在很大差异。仔细的术前规划，利用先进的影像学技术，可以帮助获得良好的结果。
我们评估了马蹄肾肿瘤的手术治疗，这种肿瘤非常罕见。尽管这些手术过程非常复杂，但结果是可以接受的。术前规划通常需要现代影像学技术。
