Succinate dehydrogenase (SDH) deficient renal cell carcinoma (RCC) is a rare subset of familial RCC with only 59 cases reported. SDH deficiency is associated with hereditary paraganglioma/pheochromocytoma syndrome. Most of the cases are solitary tumors with only two reported cases of bilateral tumor. The identification of SDH deficient RCC is often the sentinel event of patient's syndromic diagnosis. We present a case of an adolescent male with bilateral tumors in a horseshoe kidney who was treated with staged robotic-assisted partial nephrectomies without complication. Both tumors were SDH negative on immunohistochemical staining.
Background: Kidney cancer accounts for 2.6% of all visceral malignancies in the USA. Around 5–10% of patients with renal cell carcinoma (RCC) have renal venous involvement. Open nephrectomy with tumour thrombectomy has classically been the gold standard for treatment of these masses. As opposed to open surgery, minimally invasive surgery is associated with less intraoperative blood loss, shorter hospital stays, and lower complication rates. In this study, the authors present a series of robotic radical nephrectomies in patients with renal venous invasion. Materials and methods: Between November 2016 and March 2021, 10 patients with RCC with renal venous invasion underwent radical nephrectomies. In eight patients, renal venous invasion was evident based on CT. In four cases, tumour thrombus invaded the inferior vena cava. In three of these cases, the tumour thrombus was able to be milked back into the renal vein, allowing for ligation and transection in the standard fashion. In the remaining case, cavotomy and tumour thrombus extraction was required. Results: All cases were performed completely robotically, without requiring open conversion. Median operative time was 136 minutes. Median estimated blood loss was 450 mL. Median length of hospitalisation was 2.5 days. Eight patients had no complications following the procedure. Conclusion: In the setting of a community hospital, robotic management of patients with T3a and T3b RCC with venous invasion is a safe and effective alternative to open surgery.
Abstract Purpose: The purpose of this study was to evaluate the prevalence of positive periurethral lymph nodes during robotic-assisted radical prostatectomy (RARP) and to investigate the relationship between secondary end points of tumor staging, PSA, and Gleason score. Materials and Methods: This study is a retrospective review of 1177 RARPs performed from October 2011 to February 2022. Using pathology reports, the study population was condensed to 58 patients who had periurethral lymph node tissue. This population was then analyzed for the prevalence of malignant tissue in the specimen. A secondary analysis was performed for data on PSA, Gleason score (preoperative and postoperative), and tumor-nodes-metastases (TNM) staging. Results: Retrospective analysis demonstrated 9 of 58 specimens (15.5%) to be positive for malignancy. There was a statistically significant ( P < .004) correlation between lymph node status and PSA. The average PSA was 17.60 (SD = 15.54) for those with positive periurethral lymph nodes and 7.96 (SD = 6.65) for those with negative periurethral lymph nodes. There was no statistically significant association between lymph node status and preoperative Gleason scores. There was, however, a statistically significant difference across lymph node status and postoperative Gleason scores (X 2 (3) = 11.09, P = .01). Conclusion: Positive periurethral lymph nodes demonstrated higher average PSAs, postoperative Gleason scores, and TNM staging. Further analysis is required to evaluate potential prognostic implications.
