Renal cell carcinoma (RCC) represents 90% of primary renal malignancies in adults, with a significant but underreported burden in the Philippines due to limited access to specialized care. This study aims to describe the epidemiology, clinical characteristics, and outcomes of RCC patients at the Philippine General Hospital (PGH), the leading tertiary-care institution. The objective is to assess quality metrics and identify gaps in RCC management.

This retrospective study analyzed RCC cases included in the CancerSurg cohort between January and June 2024

Among 1,333 surgical cancer cases in the CancerSurg cohort, 44 (3.3%) were RCC cases, with a median age of 55.8 years and a male-to-female ratio of 3:1. Half were diagnosed incidentally, while the rest presented with symptoms. Radical or partial nephrectomy was performed in 61.4% (27/44) with curative intent, and 81.8% were elective admissions. Among the 28 index RCC surgeries, 57.1% were led by senior urology trainees, with 21.4% by specialist and non-specialist consultants each. Adequate margins were achieved in 85.7%, while 14.3% showed positive margins. Thirteen patients (29.5%) underwent non-index surgeries, mainly for diagnostic or palliative purposes. The most common non-index surgery was ultrasound-guided renal biopsy (54%), particularly in patients at high surgical risk or those who withheld consent. Other non-index surgeries (e.g., exploratory laparotomy, TURBT, PCNL) were conducted for diagnostic clarification, palliative care, or managing concurrent urological conditions. Six patients that underwent operations (13.6%) experienced complications, with half developing multimorbidity. Three patients required ICU admission due to delayed extubation and clinical deterioration, leading to two mortalities. Among the index operations, there were three morbidities but no mortalities. No surgical site infections or reoperations occurred within 30 days. Staging discrepancies existed between clinical and pathological assessments, with clinical staging indicating 36.4% T1 tumors, while pathological staging identified 34.1% T3 tumors. Histopathology reporting was optimal in only 22.7% (10/44) of cases, with the most commonly missed elements being tumor focality and nodal metastasis. Inconsistent adherence to CAP guidelines and a lack of formal policies contributed to reporting gaps, highlighting the need for standardization and training to improve completeness and accuracy.

This study described the demographic, pre-operative, intra-operative and post-operative profiles among patients with renal cell carcinoma admitted to the UP-PGH and included in the CancerSurg Study. We have noted several findings that were discrepant with global published data, with the differences likely and at least partly attributable to the unique context of the institution (a state-funded national university tertiary-care hospital at the heart of the national capital) and the lower-middle income country setting of the Philippines.