ABSTRACT
Background: Worldwide, renal cell carcinoma comprises 2.2% and 1.8% of global cancer incidence and mortality, respectively. Studies of epidemiology, treatment modalities and outcomes of renal cell carcinoma (RCC) in Sudan are scarce. To address this shortcoming, we evaluated baseline information on the epidemiology, types of treatment and outcomes of RCC at Gezira Hospital for Renal Diseases and Surgery (GHRDS) and the National Cancer Institute (NCI). Methods: We performed a retrospective, descriptive study of all patients with RCC, who were treated in GHRDS and NCI from January 2000 to December 2015. Results: A total of 189 patients with RCC were identiï¬ed over the study period. Tumours were more common among male patients (56%) and involved the left kidney in 52% of cases. The median age at diagnosis was 57 years (range: 21-90 years). Loin pain was the most frequent symptom (n = 103 patients) followed by weight loss (n = 103 patients) and haematuria (n = 65 patients). The most common histopathologic type of RCC was clear cell (73.5%), followed by papillary (13.8%) and chromophobe (1.6%). The relative frequencies of stages I-IV were 3.2%, 14.3%, 29.1% and 53.4%, respectively. The overall median survival rate was 24 months, and the 5-year survival rate was 40%. The 5-year survival rate in stages I-IV was 95%, 83%, 39%, and 17%, respectively. Advanced stages and higher-grade tumour were associated with worse survival. The median survival of stage IV patients was better for patients who underwent nephrectomy (11.0 months) compared to those who did not undergo nephrectomy (4.0 months) (p value = 0.28). Conclusion: Our findings reveal poor outcomes for patients with RCC in Sudan, which is most likely due to the high proportion of patients presenting with advanced stages at the time of initial presentation.
ABSTRACT
A well-functioning arteriovenous fistula (AVF) is essential for the maintenance of hemodialysis (HD) in patients with chronic renal failure. Our aim is to review our experience of creating AVF and to asses its success rate and common complication. A prospective, hospital-based study was conducted on 73 patients (48 males and 25 females) on chronic HD in Gezira Hospital for Renal Diseases and Surgery, from January to July 2007. Their mean age was 43.9 years (range from 18 to 72 years). Seventy-one (97.3%) of the study subjects had been dialyzed before creation of the AVF, 67 (91.8%) of them having undergone HD with temporary access. All patients (n=73) had a native AVF as the permanent vascular access (VA). A primary radiocephalic AVF was created in 78.1% of the patients, cubital fossa in 20.5% and one case had left snuff box AVF (1.4%). Percentage of AVF maturation was reported in 67.1% of the cases within the first six weeks and in 9.6% of the cases AVF never matured. Failure of AVF function occurred in 26% of the cases, due to thrombosis in 20.5% (n=15) and aneurysm in 5.5% of the cases. We conclude that an optimum outcome is likely when there is a multidisciplinary team approach, and early referral to vascular surgery is paramount.
