Glomus tumors are rare mesenchymal tumors involving cells from the glomus body, smooth muscle, and vasculature, typically found in distal extremities\' skin. This case describes a 54-year-old woman with a history of hypothyroidism and hyperlipidemia, incidentally discovered to have a four-centimeter calcified renal tumor. Surgery was performed due to suspected malignancy. Immunohistochemical staining confirmed a renal glomus tumor, positive for muscle actin and smooth muscle actin (SMA). The tumor was benign, and no adjuvant therapy was needed. The patient remained recurrence-free during follow-up. Renal glomus tumors are predominantly benign, with surgical resection as the primary treatment.

BACKGROUND: Open partial nephrectomy (OPN) has previously been considered the gold standard procedure for treatment of T1 localized renal tumors. After introduction of robot assisted partial nephrectomy (RAPN) as an alternative method to OPN, OPN was gradually abandoned at our department. The aim of the study was to retrospectively compare the results of patients treated with either OPN or RAPN for suspected renal carcinoma.
METHODS: Patients who underwent either open or robotic assisted partial nephrectomy between January 1st 2010 and December 31st 2020 were retrospectively included in the study. Each tumor subjected to surgery was scored preoperatively by the RENAL nephrometry score. Complications within 30 days were assessed according to the Clavien-Dindo classification system.
RESULTS: A total of 197 patients who underwent partial nephrectomy were identified; 75 were subjected to OPN and 122 were treated with RAPN. There were no significant differences between the groups with respect to age (OPN: 63 years ± 11, RAPN: 62 years ± 10), gender (OPN: 71/29%, RAPN: 67/33%), body mass index (OPN: 28 ± 5, RAPN: 28 ± 5), ASA score (OPN: 2.4 ± 0.6, RAPN: 2.2 ± 0.5), or nephrometry score (OPN: 6.6 ± 1.7, RAPN: 6.9 ± 1.7, p = 0.2). The operative time was significantly shorter in the OPN group (81 min) compared to the RAPN group (144.5 min, p < 0.001). Mean perioperative blood loss was 227 ± 162 ml in the OPN group compared to 189 ± 152 ml in the RAPN group (p = 0.1). Mean length of stay was shorter in the RAPN group (3 days) compared to the OPN group (6, days, p < 0.001). Positive surgical margin rate was significantly higher in the OPN group (21.6%) compared to the RAPN group (4.2%, p < 0.001). There were no differences in the number of Clavien-Dindo graded complications between the groups (p = 0.6).
CONCLUSIONS: The introduction of RAPN at our department resulted in shorter length of stay and fewer positive surgical margins, without increasing complications.

OBJECTIVE: To compare outcomes of radical (RN) and partial nephrectomy (PN) in Sarcomatoid Renal Cell Carcinoma (sRCC) utilizing a large national cohort. As RN is the reference standard for localized RCC with clinically aggressive features, PN in sRCC has been seldom studied.
METHODS: We performed a retrospective cohort analysis of the National Cancer Database from 2004 to 2019 for patients who underwent PN and RN for sRCC (T1-T3N0-N1M0). We performed multivariable analyses (MVA) to determine factors associated with PN and all-cause mortality (ACM), and Kaplan-Meier Analysis (KMA) for overall survival (OS) in Charlson 0 patients who underwent PN vs. RN according to clinical stage.
RESULTS: The cohort consisted of 5,265 patients [RN 4,582 (87.0%)/PN 683 (13.0%)]. Increased odds of receiving PN was associated with papillary RCC (OR = 1.69, p = 0.015); inversely with increasing age (OR = 0.99, p = 0.004), cT2-cT3 (OR = 0.23, p < 0.001), and cN1 (OR = 0.2, p < 0.001). Worsened ACM was associated with positive margins (HR = 1.59, p < 0.001), male (HR = 1.1, p = 0.044), Charlson [Formula: see text]2 (HR = 1.47, p < 0.001), cT2-cT3 (HR 1.17-1.39, p < 0.001-0.035), and cN1 (HR = 1.59, p < 0.001). Improved ACM was noted with PN (HR = 0.64, p < 0.001), increasing household income (HR = 0.77-0.79, p < 0.001), and private insurance (HR = 0.80, p = 0.018). KMA showed PN had improved 5-year OS compared to RN in cT1 (86.5% vs. 63.2%, p < 0.001), and cT3 (61.0% vs. 44.0% p < 0.001), but not cT2 (p = 0.67).
CONCLUSIONS: In select patients, PN with negative margins may not compromise outcomes and may provide benefit when indicated. Patients with private insurance and highest income experienced improved survival suggesting disparity in care.

Purpose: We aimed to assess the perioperative, oncological, and functional outcomes of patients aged 70 years or older following retroperitoneal laparoscopic partial nephrectomy (LPN) and compare their results with younger patients. Materials and Methods: A retrospective review of our prospectively maintained database identified 329 patients who underwent retroperitoneal LPN from January 2013 to October 2022. The patients divided into 2 groups defined by age ≥70 or <70 years at the time of surgery. A propensity score matching analysis was conducted to obtain two balanced groups. The groups were compared for safety (perioperative outcomes) and efficacy (oncological and functional outcomes). Results: After matching, all variables were well balanced with no differences between the two cohorts. No significant differences were found in perioperative outcomes, including operative time, warm ischemia time, blood loss, hospital stay, and complications (P values >.05). Concerning functional outcomes, postoperative glomerular filtration rate and decrease in glomerular filtration rate were significantly better in the younger group compared with the elderly groups (P = .003 and P = .001, respectively). Although margin, ischemia, complications rates were similar between the cohorts (P = .068), Pentafecta rates were lower in the elderly patients (P = .029). In terms of oncological outcomes, recurrence-free survival and cancer-specific survival were comparable between the groups. Conclusion: Retroperitoneal LPN can be performed safely and with adequate oncological efficacy in elderly patients.

OBJECTIVE: To assess the rate at which sutureless partial nephrectomy (SLPN) transitions to standard partial nephrectomy (SPN), focusing on preoperative factors that might prompt such conversions.
METHODS: In this retrospective study, we analyzed the efficacy of SLPN performed on adults at our institution from 2016 to 2023. The subjects were patients diagnosed with localized solid renal tumors. The primary technique employed was resection with scissors and argon beam coagulation for hemostasis, with suturing techniques used only when necessary. Predictive factors necessitating conversion to SPN were identified, and the associations among multiple variables were explored using various statistical analysis methods, including logistic regression, to identify key preoperative predictive factors.
RESULTS: Our institution performed 353 SLPN, with 21 cases (5.9%) necessitating conversion to SPN. The conversion rates for the Laparoscopic Partial Nephrectomy (LPN) subgroup and the Robotic-assist Partial Nephrectomy (RPN) subgroup were 7.9% (17/215) and 2.9% (4/138), respectively, nearing statistical significance (P = .066). Significant differences were observed between the conversion group and the no conversion group in terms of preoperative estimated Glomerular Filtration Rate (eGFR), age at surgery, tumor size, and exophytic/endophytic characteristics. Multivariate analysis identified age at surgery, preoperative eGFR, radiological tumor size, and tumor exophytic/endophytic nature as significant predictors for conversion to SPN.
CONCLUSIONS: This investigation highlights the efficacy and feasibility of SLPN while identifying critical factors influencing the necessity for conversion to SPN. The identified predictors, including younger surgical age, superior preoperative eGFR, and specific tumor characteristics, provide valuable insights for refining surgical strategies.

UNASSIGNED: This is a case of giant renal angiomyolipoma treated with partial nephrectomy without pre-embolization of the supplying arteries.
METHODS: The patient presented for regular checkup, a mass in the left flank was found on examination. No other symptoms were present. No history of medical or surgical importance was found.
UNASSIGNED: CT scan revealed a heterogenous mass in the left kidney at the upper pole. The treatment options were discussed with the patient and he opted for complete removal of the mass. Partial nephrectomy was done without pre embolization of the arteries. The procedure went without complications, the blood loss was manageable during the operation (200 cc). The patient was admitted for 48 h post operation and was discharged shortly after. The excised mass was sent for histopathological examination, the report was received, the features of the mass was consistent with angiomyolipoma without other types of malignant masses present.
CONCLUSIONS: The takeaway is that partial nephrectomy provides a convenient option for treatment of giant renal angiomyolipomas. Preservation of the renal function, reduction of the recurrence risk or re embolization of the supplying arteries makes it a viable alternative for other treatment modalities.

BACKGROUND: In surgically excising renal masses, studies have demonstrated that tumor enucleation is an effective option. However, there is limited literature comparing off-clamp to on-clamp tumor enucleation.
METHODS: We retrospectively reviewed the charts of 189 patients who underwent robotic-assisted laparoscopic partial nephrectomy via tumor enucleation by a single surgeon from March 2012 and April 2022. Patients were stratified based on use of renal hilar clamping intraoperatively. Surgical, oncologic, and renal functional outcomes were captured. Variables were analyzed and compared between the two groups using Student\'s T-tests and Chi-square tests.
RESULTS: Of 189 procedures analyzed, 124 were performed on-clamp and 65 were performed off-clamp. There were no differences in patient demographics or average length of follow-up. There were no differences in estimated blood loss, complications, or hospital length of stay. Recurrence rates were similar for the two groups. The absolute difference in estimated glomerular filtration rate change between the two groups at time of first follow-up was not significant (p = 0.25).
CONCLUSIONS: There is no significant difference in perioperative outcomes such as surgical time, blood loss, or complications between the two groups. Furthermore, there was no significant difference in postoperative kidney function between the two techniques.

The safety and efficacy of single-port and multi-port robot-assisted partial nephrectomy (SP-RAPN and MP-RAPN, respectively) were assessed for treating partial nephrectomy in this study. A systematic review of PubMed, Cochrane Library, and Web of Science databases was conducted up to June 2024 to compare studies on SP-RAPN and MP-RAPN. Primary outcomes included perioperative results, complications, and oncological outcomes. Eight studies involving 1014 patients were analyzed. For binary outcomes, comparisons were performed using odds ratios (OR), and for continuous variables, weighted mean differences (WMD) with 95% confidence intervals (CI). The search failed to discover significant meaningful variations in operating times (p = 0.54), off-clamp procedure (P = 0.36), blood loss (p = 0.31), positive surgical margins (PSMs) (p = 0.78), or major complications (Clavien-Dindo grade ≥ 3) (p = 0.68) between SP-RAPN and MP-RAPN. However, shorter hospital stays (WMD - 0.26 days, 95% CI - 0.36 to - 0.15; p < 0.00001) and longer warm ischemia times (WIT) (WMD 3.13 min, 95% CI 0.81-5.46; p = 0.008) were related to SP-RAPN, and higher transfusion rate (OR 2.99, 95% CI 1.31-6.80; p = 0.009) compared to MP-RAPN. SP-RAPN performed better in terms of hospital stay but had slightly higher rates of transfusion, off-clamp procedures, and warm ischemia time (WIT) compared to MP-RAPN. As an emerging technology, preliminary research suggests that SP-RAPN is a feasible and safe method for carrying out a nephrectomy partial. However, compared to MP-RAPN, it shows inferior outcomes regarding (WIT) and transfusion rates.

Renal cell carcinoma (RCC) is the most common solid tumor in the kidney (90%), accounting for about 3% of all cancers in adults. Partial nephrectomy (PN) is the surgical procedure primarily used for the treatment of localized kidney tumors. Two commonly used terms to describe the complexity and success of a partial nephrectomy procedure are \"trifecta\" and \"pentafecta.\" Trifecta is defined as Warm ischemia time (WIT) ≤ 25min or Cold ischemia time (CIT) ≤ 60min, Negative surgical margin (NSM), and no perioperative Clavien-Dindo complications (CDC) of Gr 3 or more [8], whereas pentafecta is defined as trifecta plus >90% preservation of e-Glomerular filtration rate (GFR) and no increase in chronic kidney disease (CKD) stage at 12-months post-operative period. We retrospectively analyzed all patients who underwent partial nephrectomy at a single high-volume tertiary centre, from 2012 to 2020. We included patients who underwent partial nephrectomy by any of the three routes including open (OPN), laparoscopic (LPN), or robotic-assisted (RPN), and in which the follow-up data was available. We compared the trifecta and pentafecta outcomes across the three surgical modalities. We had a total of 183 patients in our study. Twenty-nine percent (53 patients) underwent open surgery, 12.6% (23 patients) underwent laparoscopic surgery and 58.5% (107) underwent robotic assisted surgery. The number of patients who fell under the low risk category in the RENAL scoring system were 70(38.3%), intermediate risk 79 (43.2%) and high risk 34 (18.6%). In the high risk RENAL score group, trifecta was achieved in 5 (50%) patients in OPN, 1(50%) in LPN and 7(31.8%) in RPN with no statistically significant difference (p = 0.581) whereas pentafecta was achieved in 3 (30%) patients in OPN, 1 (50%) in LPN and 7 (31.8%) in RPN with no statistically significant difference (0.855). In the overall cohort, mean WIT, mean hospital stay and mean EBL were higher in OPN as compared to LPN and RPN which was statistically significant (p < 0.001), whereas there was no statistical difference in mean operative time between the three modalities (p = 0.580). Renal tumors can be safely treated by RPN or LPN with lesser morbidity as compared to OPN. Trifecta and Pentafecta outcomes had no significant difference among OPN, LPN, and RPN. RPN and LPN may be considered feasible and safe surgical approaches ensuring good functional outcomes.

BACKGROUND: Renal cell carcinoma is one of the 10 most common malignancies. Partial nephrectomy (PN) is the preferred treatment for localized ones. The incidence of local recurrence (LR) after a PN varies between zero and 17% in the literature. Managing a LR following PN is a challenging situation, both ablation therapy and salvage surgery are viable options.
METHODS: A 38-year-old woman with a history of a right open partial nephrectomy performed on an ectopic kidney four years ago, presented a loco regional recurrence, involving the right ovary and rectus muscle, which we managed by a radical nephrectomy with bilateral oophorectomy et resection of the rectus muscle nodules.
UNASSIGNED: LR of RCC after PN presents a clinically challenging scenario. Treatment options include ablative therapy or surgical salvage therapy, which can be either by radical nephrectomy or by repeat partial nephrectomy. Ablative therapy has less complication rate and is preferred for small LR or on a solitary kidney. Repeat PN is also an option for preserving renal function but with high risk of complication. RN is an option if PN is technically challenging, especially in patients with a functional contralateral kidney.
CONCLUSIONS: Recurrent renal cell carcinoma (RCC) can manifest differently based on the primary treatment, as well as tumor and patient characteristics. Managing a LR following PN is a challenging situation, both ablation therapy and salvage surgery are viable options.