Bilateral synchronous sporadic renal cell carcinoma: surgical management, oncological and functional outcomes

Abstract

RESULTSAfter excluding four patients (7%) with bilateral benign renal tumours, six (11%) with metastatic bilateral RCC and three (5%) who had bilateral RN, the cancer-specific outcome was analysed. For 44 patients with bilateral RCC who had surgery with intent to cure and avoid dialysis, 13 (30%) had stage pT1a, 10 (23%) pT1b, nine (17%) pT2 and 12 (27%) pT3 disease. At 5 and 10 years, the cancer-specific survival rates were 86% and 75%, and the local recurrence-free survival rates were 87% and 80%. The median serum creatinine level at the latest follow-up was 1.18 mg/dL in patients after bilateral NSS and 1.40 mg/dL after unilateral NSS and contralateral RN ( P < 0.05). CONCLUSIONSThese long-term data support the concept that NSS, whenever possible bilateral, is the treatment of choice for bilateral synchronous sporadic RCC. NSS provides adequate local tumour control and cancer-specific survival. Preservation of renal function is more efficient with bilateral NSS than with unilateral NSS and contralateral RN.

Developments in the surgical management of sporadic synchronous bilateral renal tumours

“…Of patients with synchronous BRTs, 53% had bilateral PNs. Pahernik et al [23] described the approach at Johannes Gutenberg University in Mainz, which involves bilateral staged PNs when possible, similar to the M.D. Anderson, and they generally preferred to operate on the more favourable tumour first.…”

Tumor Recurrence Following Nephron-Sparing Surgery for Renal Cancer: Rate, Patterns, and Predictors

“…Similar results have been reported by others. Pahernik et al [21] reported 5-year and 10-year cancer-specific survival rates of 86% and 75%, respectively, and freedom from local recurrence of 87% and 80%, respectively, in 44 patients with bilateral tumors undergoing NSS. Dimarco et al [22] reported a higher rate of contralateral recurrence for patients with multifocal clear-cell RCC than for patients with solitary tumors (risk ratio 2.91; P = .142).…”

Bilateral kidney cancer

“…Pahernik и соавт. [8] представили результаты ле-чения 57 больных спорадическим синхронным двусто-ронним ПКР. Радикальную нефрэктомию с резекцией контралатеральной почки выполнили у 28 (49%) пациен-тов, двустороннюю резекцию почек -у 22 (39%), двусто-роннюю нефрэктомию -у 3 (5%) больных.…”

“…Результатом миграции стадии ПКР стала смена стандартов хирурги-ческого лечения, а также увеличение продолжительности жизни пациентов, что в свою очередь может способство-вать увеличению числа случаев выявления метахронного ПКР [3][4][5][6][7][8][9][10][11].…”