Abstract：Objective: To discuss the surgical strategy in treating synchronous sporadic bilateral renal cell carcinoma. Methods: Clinical and pathological data of 64 patients with synchronous sporadic bilateral renal cell carcinoma were analyzed retrospectively. Of all the 64 patients, 47 patients were males and 17 were females, the mean age was 51 (25-69) years. 59 patients without symptoms were diagnosed with bilateral renal cell carcinoma during regular check-up, 2 patients presented with hematuria and 3 with backache. None of these patients presented with lymphatic or distant metastasis. 38 patients were diagnosed with T1a tumors, 17 with T1b and 9 with T2a. Results: All the 64 patients underwent bilateral retroperitoneoscopic surgeries. Of the 4 patients undergoing single procedures, 2 patients developed acute renal failure and acquired temporarily hemodialysis. Of the 60 patients undergoing staged procedures,bilateral NSS was performed in 34 patients (NSS-NSS group), RN followed by NSS in 19 patients (RN-NSS group)and NSS followed by RN (NSS-RN group) in 7 patients. The mean sCr of each group after bilateral surgeries were 89 μmol/L, 110 μmol/L, 102 μmol/L, respectively. 1 patientundergoing bilateral RN required routine hemodialysis. The median follow up time was 49 (7-99) months. 50 patients survived without tumor, 2 patients developed local recurrence, 5 patients suffered from lymphatic or distant metastasis and 7 patients died in the last follow up. Conclusions: Retroperitoneoscopic staged NSS was the preferred choice for the management of synchronous sporadic bilateral renal cell carcinoma, which was superior in renal functional preservation with the complete resection of tumors. There was not a significant difference in the prognosis between patients with synchronous sporadic bilateral renal cell carcinoma and unilateral renal cell carcinoma.
[1]Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin, 2013, 63(1):11-30.
[2]Gregory GB, Victor R, Paul R, et al. Bilateral non-familial renal cell carcinoma. Ann SurgOncol, 1998:5(6):548-552.
[3]Klatte T, Wunderlich H, Patard JJ, et al. Clinicopathological features and prognosis of synchronous bilateral renal cell carcinoma:an international multicentre experience. BJU Int, 2007, 100(1):21-25.
[4]Klatte T, Patard JJ, Wunderlich H, et al. Metachronous bilateral renal cell carcinoma:risk assessment, prognosis and relevance of the primary-free interval. J Urol, 2007, 177(6):2081-2086.
[5]Lu JS, Zhang X, Gao JP, et al. Laparoscopic-assisted partial nephrectomy combined with open procedure for posteromedial renal tumors. Urology, 2010, 76(6):1414-1418.
[6]Zhang X, Li HZ, Ma X, et al. Retroperitoneal laparoscopic nephron-sparing surgery for renal tumors:Report of 32 cases. Urology, 2005, 65(6):1080-1084.
[7]Blute ML, Itano NB, Cheville JC, et al. The effect of bilaterality, pathological features and surgical outcome in nonhereditary renal cell carcinoma. J Urol, 2003, 169(4):1276-1281.
[8]Blute ML, Amling CL, Bryant SC, et al. Management and extended outcome of patients with synchronous bilateral solid renal neoplasms in the absence of von Hippel-Lindau disease. Mayo Clin Proc, 2000, 75(10):1020-1026.
[9]Jacobs BL, Gibbons EP, Gayed BA, et al. Management of bilateral synchronous renal cell carcinoma in a single versus staged procedure. CanJ Urol, 2009,16(1):4507-4511.
[10]Lowrance WT, Yee DS, Maschino AC, et al. Developments in the surgical management of sporadic synchronous bilateral renal tumours. BJU Int, 2010, 105(8):1093-1097.
[11]Patel MI, Simmons R, Kattan MW, et al. Long-term follow-up of bilateral sporadic renal tumors. Urology, 2003, 61(5):921-925.
[12]Booth J, Matin SF, Ahrar K, et al. Contemporary strategies for treating nonhereditary synchronous bilateral renal tumors and the impact of minimally invasive, nephron-sparing techniques. Urol Oncol, 2008, 26(1):37-42.
[13]Simmons MN, Brandina R, Hernandez AV, et al. Surgical management of bilateral synchronous kidney tumors:functional and oncological outcomes. J Urol, 2010, 184(3):865-872.
