Contemporary surgical management of renal oncocytoma: a nation's outcome

OBJECTIVES: To report on the contemporary UK experience of surgical management of renal oncocytomas. SUBJECTS AND METHODS: Descriptive analysis of practice and postoperative outcomes of cases with a final histological diagnosis of oncocytoma included in The British Association of Urological Surgeons (BAUS) nephrectomy registry from 01/01/2013 to 31/12/2016. Short term outcomes were assessed over a follow-up of 30 days. RESULTS: Over 4 years, 32130 renal surgical cases were recorded in the UK, of which 1202 were oncocytomas (3.7%). Most patients were male (n=756; 63.3%), the median age was 66.8 years (interquartile range (IQR) 13). Median lesion size was 4.1cm (IQR 3; range 1-25cm), 43.5% were ≤4cm and 34.2% were 4 to 7cm lesions. Thirty-five patients (2.9%) had preoperative renal tumour biopsy. The majority of patients had minimally invasive surgery, either radical (n=683; 56.8%), partial nephrectomy (n=483; 40.2%) or other procedures (n=36; 3%). One in five (n=253; 20.2%) patients had in-hospital complications: 48 were Clavien-Dindo classification grade III or above (4% of total cohort), including 3 deaths. Two additional deaths occurred within 60 days of surgery. The analysis is limited by the study's observational nature, not capturing lesions on surveillance or ablated after biopsy, possible underreporting, short follow-up, and lack of central histology review. CONCLUSION: We report on the largest surgical series of renal oncocytomas. In the UK, the complication rate associated with surgical removal of a renal oncocytoma was not negligible. Centralisation of specialist services and increased utilisation of biopsy may inform management, reduce overtreatment, and change patient outcomes for this benign tumour. This article is protected by copyright. All rights reserved.