Synchronous bilateral renal cell carcinoma: Total surgical excision

Jacobs, Stephen C.; Berg, Solomon; Lawson, Russell K.

doi:10.1002/1097-0142(19801201)46:11<2341::aid-cncr2820461103>3.0.co;2-o

Cited by 95 publications

(24 citation statements)

References 38 publications

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“…Im Schrifttum wurden bisher 112 Fälle von doppelseitigen synchronen Hypernephromen erfaßt. 61 dieser Fälle wurden von Jacobs et al registriert (17), die übrigen Fälle stammen aus Einzelmitteilungen (Tab. 1).…”

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Das bilaterale Hypernephrom

Sparwasser¹,

Bach²,

Sparwasser³

et al. 1984

Aktuel Urol

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“…Lebensjahrzehnt (19,22,25,36). Männer sind häufiger betroffen (17,25,34,46). In der Mehrzahl der Fälle sind die Tumoren polständig (24,27).…”

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Das bilaterale Hypernephrom

Sparwasser¹,

Bach²,

Sparwasser³

et al. 1984

Aktuel Urol

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“…Of our own patients, 23 exhibited bilateral tumors, either synchronously or metachronously, in one case 15 years after the first operation. The major concern regarding the use of organ-preserving surgery for renal cell carcinoma in patients with a normal contralateral kidney is the risk of multifocality, for which an incidence of 0.5 to 5% is reported in the literature [2,6,10,22]. Excluded from this argumentation are patients with von Hippel-Lindau's disease, of whom 75°7o have bilateral tumors [9] and in whom multiple recurrent lesions are common.…”

Section: Discussionmentioning

confidence: 99%

Parenchyma-sparing surgery for renal tumors

Stöckle¹,

Thüroff²,

Störkel³

et al. 1991

World J Urol

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Between 1969Between und 1989 conservative surgery for kidney tumors was performed in 123 patients. In 49 patients there was an imperative indication for a parenchyma-sparing operation because nephrectomy would have made dialysis obligatory. Thirty-five of these 49 patients show no signs of tumor progression after a mean follow-up of 4.5 years. Known metastases were present in 3 of 6 patients who died as a result of their tumors. In two patients there was a recurrence after 1 and 5 years, respectively, requiring a second organ-preserving operation. In one further patient we suspect that multiple small tumor lesions may be present 2 years after the first operation. In 74 patients with a healthy contralateral kidney the tumor was enucleated by choice (elective indication). Sixty-eight of these 74 patients show no signs of tumor progression after a mean follow-up period of 3.3 years. One patient died from tumor metastases. Two patients had tumor recurrence, requiring nephrectomy and enucleation, respectively. Fifty-seven enucleated tumors were available for image analysis DNA cytometry. Only the two patients with a hypertriploid tumor died from their cancer.Until now radical nephrectomy has been regarded as standard therapy for non-metastasized renal cell carcinoma [15,18,21]. This operation has been accepted because of its theorized advantage of more complete resection. A parenchyma-sparing operation has only been performed on patients in whom radical nephrectomy would result in renal failure requiring hemodialysis (imperative indication), such as those with a single kidney, bilateral tumors, dysfunctional contralateral kidney or chronic renal failure. However, the widely used partial nephrectomy in these instances may result, in certain cases, in insufficient residual renal parenchyma [14]. Simple enucleation of the tumor, together with a small surrounding margin of normal renal tissue, is an alternative technique to this * To whom correspondence should be addressed approach. The surprisingly good prognosis of patients, which were treated by enucleation in the imperative group [1], encouraged us over the past 9 years to perform parenchyma-sparing operations also on patients with small peripheral tumors and normal contralateral kidneys (elective indication). In addition, these small and mostly asymptomatic kidney tumors, which only a few years ago were rarely diagnosed, are being detected more frequently by ultrasound. Thus, the incidence of asymptomatic renal tumors increased from 10% in 1978 to 70°70 in 1989, while the classic symptoms of flank pain, hematuria and palpable mass were found in less than 10% of the cases, Here we present the operative technique, complications, patient outcome and preliminary results of image analysis DNA cytometry. Between 1969 and, conservative surgery of kidney tumors was performed in 123 patients. Conservative surgery was imperative for 49 of the patients (18 female, 31 male) aged 38 to 77 years (average age 59 years). A total of 23 patients had metachronous or synchronous bila...

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“…Historically, nephronsparing approaches were mostly limited to those patients who would be rendered anephric if treated with radical nephrectomy (tumor in a solitary kidney or bilateral synchronous tumors) and those who had conditions which threatened the function of an uninvolved contralateral kidney (renal artery stenosis, pyelonephritis and calculus disease, among others) [16]. Initial successes with these imperative and so-called relative indications reflected improvements in surgical technique and offered insights into the oncologic durability of local excision [17,18]. The demonstrated safety and feasibility of nephron-sparing procedures in well selected patients, growing appreciation of deleterious effects of renal insufficiency, and the increasing number of small incidentally found tumors has led to the use of partial nephrectomy in patients with normal contralateral kidneys [19,20].…”

Section: Reviewmentioning

confidence: 99%

Surgical management of large renal tumors

Vourganti

Shuch

Bratslavsky

2011

Expert Review of Anticancer Therapy

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The surgical management of patients with renal cell carcinoma has undergone many changes. With equivalent oncologic outcomes and appreciation of the importance of renal functional preservation, the utilization of nephron-sparing partial nephrectomy has increased in recent years. Nevertheless, tumors of larger size continue to be preferentially treated with radical nephrectomy. Here, we present evidence that improvements in techniques and durability of oncologic outcomes has justified the use of nephron sparing to accomplish renal functional preservation even in patients with large renal tumors. In addition, surgical technical considerations when managing such tumors are discussed. Finally, we discuss cytoreductive surgery and the evolving role of systemic targeted therapies in the management of advanced metastatic disease.

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Synchronous bilateral renal cell carcinoma: Total surgical excision

Cited by 95 publications

References 38 publications

Das bilaterale Hypernephrom

Das bilaterale Hypernephrom

Parenchyma-sparing surgery for renal tumors

Surgical management of large renal tumors

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