For a study, researchers sought to assess the treatment, surgical results, and pathological findings in patients with tumors in a horseshoe kidney (HK). Due to abnormal vascular architecture and the possibility of renal insufficiency, HK patients pose particular difficulties. The hypothesis was that many cancers in the situation might be benign or sluggish.

In the review of renal mass patients treated in HK at the institution from 1999 to 2021, the following factors were examined: baseline traits, surgical strategy, complications, functional results, pathology, and survival.

About 43 treatments, including 24 nephron-sparing surgeries (NSS) and 19 radical nephrectomies, were carried out on 42 patients with HK (RN: splitting the isthmus & saving the contralateral moiety). Around 22 partial nephrectomy (PN) procedures and 2 thermal ablations were part of the NSS. 4.3 cm was the median tumor size. There were 18 minimally invasive instances (42%), 17 open midlines, and 8 different open methods. Clavien III-V complications occurred at a 12% rate after 90 days, with no fatalities. The median warm and cold ischemia times for PN were 26/31, respectively. On histology, only 22 tumors (51%) were either benign (n = 10) or low grade, restricted RCC (n = 12), and only 27 tumors (63%) were renal-cell carcinoma (RCC). Following NSS, the eGFR was 82/83/78 mL/min/1.73 m2  at preoperative, new baseline, and long-term, compared to 75/48/57 mL/min/1.73 m2 after RN. Three patients (7%) required long-term dialysis. A 36-month median follow-up period. NSS had an 83% 5-year recurrence-free survival rate compared to RN’s 66%.

In HK, managing renal masses is difficult, and need for diversity in the use of several surgical techniques. In most patients, renal function was preserved, and NSS was found to provide a functional advantage. When possible, preoperative renal mass biopsy should be taken into consideration since RCC was less common than anticipated while benign and non-aggressive tumors were more common.

Reference: goldjournal.net/article/S0090-4295(22)00263-1/fulltext