Department of Urology, Mayo Clinic, Rochester, MN.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
Urology. 2023 Sep;179:87-94. doi: 10.1016/j.urology.2023.06.002. Epub 2023 Jun 17.
To contrast surgical outcomes of Horseshoe Kidney (HSK) patients with localized renal masses suspected of cancer with nonfused nonectopic kidney patients, emphasizing safe surgical practices for HSKs.
The study examined solid tumors from the Mayo Clinic Nephrectomy registry between 1971 and 2021. Each HSK case was matched to three non-HSK patients based on various factors. The outcomes measured included complications within 30days of surgery, change in estimated glomerular filtration rate, and overall, cancer-specific, and metastasis-free survival rates.
Thirty of the 34 HSKs had malignant tumors compared with 90 of the 102 patients in the nonfused nonectopic referent cohort. Accessory isthmus arteries were present in 93% of HSK cases, with 43% exhibiting multiple arteries and 7% with 6 or more arteries. Estimated blood loss and surgery duration were significantly higher in HSKs (900 vs 300 mL, P = .004; 246 vs 163 minutes, P < .001, respectively). The HSK group demonstrated an overall complication rate of 26% (vs 17% in referents, P = .2) and a median change in estimated glomerular filtration rate at 3months of - 8.5 (vs -8.1 in referents, P = .8). At 5-year follow-up, survival rates for HSK patients were 72%, 91%, and 69% for overall, cancer-specific, and metastasis-free survival, respectively. The corresponding rates were 79%, 86%, and 77%, respectively, for matched referent patients (P > .05).
HSK tumor management is technically challenging with higher blood loss; however, the data demonstrate comparable outcomes for patients with HSK tumors, including complications and survival, to those without HSKs in experienced centers.
对比疑似癌症局限性肾肿块的马蹄肾（HSK）患者与非融合非异位肾患者的手术结果，强调 HSK 安全手术实践。
该研究检查了 1971 年至 2021 年间梅奥诊所肾切除术登记处的实体肿瘤。根据各种因素，每个 HSK 病例都与三个非 HSK 患者相匹配。测量的结果包括手术后 30 天内的并发症、估算肾小球滤过率的变化以及总生存率、癌症特异性生存率和无转移生存率。
34 例 HSK 中有 30 例为恶性肿瘤，而非融合非异位参照队列中有 102 例患者中有 90 例为恶性肿瘤。93%的 HSK 病例存在副峡部动脉，其中 43%存在多条动脉，7%存在 6 条以上动脉。HSK 的估计失血量和手术时间明显更高（900 与 300ml，P=0.004；246 与 163 分钟，P<0.001）。HSK 组的总并发症发生率为 26%（参照组为 17%，P=0.2），估算肾小球滤过率在 3 个月时的中位数变化为-8.5（参照组为-8.1，P=0.8）。在 5 年随访时，HSK 患者的总体生存率分别为 72%、91%和 69%，分别为总体生存率、癌症特异性生存率和无转移生存率。匹配参照患者的相应生存率分别为 79%、86%和 77%（P>0.05）。
HSK 肿瘤管理技术上具有挑战性，失血较多；然而，数据表明，在经验丰富的中心，HSK 肿瘤患者的结果与无 HSK 患者的结果相当，包括并发症和生存率。
