目的:对比马蹄肾(HSK)患者的手术结果,其中有疑似癌症的局限性肾脏肿块与非融合的非异位肾脏患者,强调HSK的安全手术方法。
方法:该研究检查了1971-2021年间梅奥诊所肾切除术注册的实体瘤。根据各种因素,每个HSK病例与三名非HSK患者相匹配。测量的结果包括手术后30天内的并发症,eGFR的变化,总的来说,癌症特异性,和无转移生存率。
结果:34例HSKs中有30例患有恶性肿瘤,而非融合非异位参考队列中102例患者中有90例患有恶性肿瘤。93%的HSK病例存在副峡部动脉,43%表现出多个动脉,7%表现出6个或更多动脉。HSKs的估计失血量和手术时间显着增加(900vs.300ml,P=0.004;246与163分钟,分别为P<0.001)。HSK组的总体并发症发生率为26%(与17%的对象,p=0.2),3个月时eGFR的中位数变化为-8.5(vs.-8.1在引用中,p=0.8)。在5年的随访中,HSK患者的生存率为72%,91%,总体来说是69%,癌症特异性,和无转移生存率,分别。相应的比率为79%,86%,77%,分别,匹配的参考患者(p>0.05)。
结论:HSK肿瘤治疗在技术上具有挑战性,出血较多;然而,数据显示HSK肿瘤患者的结果相当,包括并发症和生存率,那些在有经验的中心没有HSK的人。
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.