RESUMO
This retrospective study aims to describe the characteristics of renal cell carcinoma (RCC) in Saudi Arabia, in terms of epidemiology, clinical presentation, tumor subtype, Fuhrman grade, tumor size and stage, and overall survival. A total of 431 adult patients with a histopathological diagnosis of RCC between 2015 and 2023 were included in the analysis. Most patients (72.4%) had clear cell tumors, followed by chromophobe (15.1%) and papillary (12.5%) subtypes. In males, papillary RCC (85.2%) was more common compared to clear cell (59.8%) and chromophobe (67.7%) subtypes. Significant differences were observed in median body mass index (BMI) across tumor subtypes, and papillary tumor patients exhibited the highest incidence of hematuria (33.3%) compared to other subtypes. The Fuhrman grade also varied significantly among RCC types. Survival times were found to be lower for patients with papillary tumors. No significant difference was observed based on patients' nationality. This study can inform clinical decision-making on patient prognosis and management as well as public health efforts aimed at reducing the alarming rise of RCC incidence.
RESUMO
The utility of partial nephrectomy (PN) in locally advanced, stage T3 renal cell carcinoma (RCC) is controversial. This retrospective study aimed to review the oncological and functional outcomes of patients with T3a RCC who underwent PN. We included all patients with pT3a stage RCC undergoing either open, laparoscopic, or robotic PN at our center between January 2015 and 2023. A Wilcoxon rank sum test was utilized to compare nephrectomy types (radical nephrectomy [RN] vs PN). Survival analysis was conducted using Kaplan-Meier plots and a log-rank test. P-value < 0.05 indicated statistical significance. There were no significant differences in demographic characteristics between the RN and PN groups, except age (53.0 vs 6.5, respectively; P = 0.012) and body mass index (28.7 vs 34.3, respectively; P = 0.020). Furthermore, there were also no significant differences in the rates of local recurrence (P = 0.597), metastatic progression (P = 0.129), and chemotherapy use (P = 0.367) between nephrectomy types. Patient survival did not differ significantly based on the type of nephrectomy (log-rank P-value = 0.852). Together, our findings indicated that PN and RN yield near-equivalent oncological outcomes in terms of local recurrence, metastasis, and overall survival rates among pT3a RCC patients during a nearly 3-year follow-up period.
RESUMO
INTRODUCTION: With the high rates of obesity worldwide, laparoscopic sleeve gastrectomy (LSG) has become a very popular procedure. Due to its simple technique, rare complications might be overseen. Gastric leaks and fistula are fairly uncommon complications. In comparison to other types of fistulas, gastrobronchial fistulas are rarer with serious complications. Definitive management is yet to be determined. We intend to explore the literature on the management approach of such patients. PRESENTATION OF CASE: A 46-year-old male, presented with on/off abdominal pain, productive cough, and vomiting. The patient had left sided rhonchi on examination. In addition to a history of laparoscopic sleeve gastrectomy (LSG) 4 years ago. Imaging confirmed the presence of a gastrobronchial fistula. Conservative and endoscopic treatment failed. Consecutively, surgery was indicated. A laparoscopic mini gastric bypass with refashioning of gastric fistula edges and closure with graham patch was done. CONCLUSION: Given the increasing number of such surgeries performed the recognition of acute and chronic complications, and their optimal management is of great importance. Although performing a Roux-en-Y fistulojejunostomy was recommended in the literature, conservative and endoscopic treatment should be considered before.