Partial and Radical Nephrectomy for Unilateral Synchronous Multifocal Renal Cortical Tumors

Abstract

Objective To evaluate clinicopathologic characteristics and treatment outcomes of patients undergoing partial (PN) or radical nephrectomy (RN) for unilateral synchronous multifocal renal tumors. Methods We retrospectively reviewed medical records for 128 patients with non-metastatic unilateral synchronous multifocal renal tumors who underwent surgical resection at our institution from 1995 to 2012. Five patients with hereditary renal cell carcinoma were excluded. Differences between patient and tumor characteristics from the two nephrectomy groups were evaluated. Outcomes in terms of recurrence-free survival, overall survival, and chronic kidney disease upstaging were estimated using Kaplan-Meier methods. The log-rank test was used for group comparisons. Results The study cohort included 78 PN patients (63%) and 45 RN patients (37%); 17/95 planned PN (18%) were converted to RN. Tumor diameter and R.E.N.A.L. nephrometry scores were greater in RN patients (p<0.0001 and p=0.0002, respectively). Pathological stage T3 was seen in 40% of RN patients and 10% of PN patients (p=0.0002). Histologic concordance was apparent in 60/123 patients (49%). Median follow-up for patients alive without a recurrence was 4 years. Five-year recurrence-free survival was 98% for PN and 85% for RN. Five-year overall survival was 96% for PN and 86% for RN (p=0.5). Five-year freedom from chronic kidney disease upstaging was 74% for PN, and 55% for RN (p=0.11). Conclusion Partial nephrectomy for the treatment of unilateral synchronous multifocal renal tumors with favorable characteristics was associated with a low recurrence rate. These findings suggest PN is an appropriate management strategy for this group of carefully selected patients.

Oncologic outcomes of nephron-sparing surgery in patients with T1 multifocal renal cell carcinoma

“…Due to the mulitfocality nature of the tumors, it is theoretically possible for residual tumors to still be present after the surgery. However, most studies have shown that NSS did not increase the rate of tumor recurrence, as well as cancer-specific survival [12][13][14]. Our study identified 21 patients with multifocal RCC who had undergone NSS presented with recurrence and 11 who had undergone RN.…”

Radiologically missed synchronous ipsilateral renal tumours with varying histology

“…With respect to management, Mano et al, in their retrospective analysis, reported a shift in practice over the years for the surgical treatment of unilateral synchronous multifocal RCCs, as 82% of patients previously underwent radical nephrectomy (RN) between 1995 and 2000, compared with 32% who underwent RN between 2001 and 2012. 11 A trend has developed toward more-frequent use of PN approach. Their study, which included 128 patients, revealed a five-year recurrence-free survival of 98% for PN and 85% for RN but a statistically insignificant difference in five-year overall survival.…”

“…Their study, which included 128 patients, revealed a five-year recurrence-free survival of 98% for PN and 85% for RN but a statistically insignificant difference in five-year overall survival. 11 They attribute this difference in recurrence to the fact that patients who underwent PN had more favourable tumour characteristics. As for overall survival, Siracusano and colleagues showed that multifocality is not an independent risk factor for mortality.…”

Ipsilateral synchronous clear and papillary renal cell carcinoma: A case report and review of the literature

“… 11 , 15 In addition, when they compared the 2 main surgical options for managing this subset of patients, similar tumor-specific survival was observed for patients treated with nephron-sparing surgery NSS and radical nephrectomy RN in carefully selected patients. 7 , 11 , 12 , 15 , 18 …”