Renal tumours show decreasing size at presentation at Korle Bu Teaching Hospital in Accra

Abstract

BACKGROUND In Ghana, a study by Klufio et al indicated that renal tumours constituted 10.4% of genito-urinary cancers seen at the Korle Bu Teaching Hospital. It has been observed that most patients in developing countries present with symptoms and present with relatively large or advanced tumours affecting prognosis. There has been an increase in the availability of and access to the use of imaging such as ultrasound, CT scan and MRI in Southern Ghana. Its impact on renal tumour size at presentation in Ghana is yet to be determined. The objective of this study is to analyse the clinicopathological features of renal tumours managed from 2000-2011 and that of 2015-2022 in the presence of an increased availability of imaging studies in the country with the hypothesis that renal tumour size at presentation will decrease with increased availability of imaging studies. METHODS This is a prospective study of the records of consecutive adult patients who underwent nephrectomy at the Department of Surgery and Urology at the Korle Bu Teaching Hospital (KBTH) in Accra from 2000 to 2011 and those from 2015- 2022 at KBTH. The parameters considered included patients’ age, gender, and indication for the nephrectomy. The laterality, size and stage of the disease, and the peri-operative outcomes were also recorded. The data were analysed using the Statistical Package for the Social Sciences (SPSS) for Windows Version 19.0. RESULTS: For the period 2000 to 2011, a total of 53 patients who underwent open radical nephrectomy were histologically confirmed to be malignant. The mean age was 52.2 ± 15.5 years (range 19 – 74 years), while that of 2015- 2022 was 150 cases with a mean age of 50.2 ± 14.9 years (15-85 years). In relation to the gender, for those managed from 2000-2011, the male to female ratio was 1:0.9 compared to 2015- 2022 (M: F=1:0.7). With regards to the laterality, 2000-2011, Right - 60.4% (32/53) Left - 39.6% (21/53) and 2015-2022, Right 46.7% and Left 53.3%. Considering the main symptoms, 2000-2011, patients had flank pain in 67.9%, flank mass in 50.9% and Haematuria in 24.5% while in 2015-2022, flank pain was 68% with flank mass and haematuria being 31% each. With regards to tumour size, for 2000-2011, mean tumor size was 16.8 ± 4.0 cm (range 10 – 28 cm), and that of 2015- 2022 with mean tumour size of 11.7 ± 6.4cm (range 4-30cm) (P<0.0001) The peri-operative mortality rate was 5.7% (3/53) for 2000-2011 and 3.3% (5/150) for 2015-2022, mainly due to haemorrhage.

CONCLUSION There has been significant reduction in the size of renal tumours seen at Korle Bu Teaching hospital corresponding to the increased access to imaging studies, however, the size reduction has not impacted on management as radical nephrectomy is the modality most used as the current size at presentation does not allow for renal sparing procedures such as partial nephrectomy.

LIMIT: Single institution Study, Patients that had Surgery