Developments in the surgical management of sporadic synchronous bilateral renal tumours Journal Article

   

Authors:	Lowrance, W. T.; Yee, D. S.; Maschino, A. C.; Cronin, A. M.; Bernstein, M.; Thompson, R. H.; Russo, P.
Article Title:	Developments in the surgical management of sporadic synchronous bilateral renal tumours
Abstract:	Objective To examine our experience with managing sporadic bilateral renal masses, focusing on trends in surgical management over time, because as loss of renal function is associated with adverse cardiovascular outcomes, nephron-sparing approaches are increasingly emphasized in the treatment of kidney tumours, creating new challenges for the treatment of bilateral tumours. Patients and Methods We identified all patients who underwent partial or radical nephrectomy (PN or RN) at Memorial Sloan-Kettering Cancer Center (MSKCC) during 1989-2008. We compared patients presenting with synchronous bilateral renal masses with those with unilateral tumour and evaluated trends in management using logistic regression. Results Of the 2777 patients studied, 73 (3%) presented with synchronous bilateral disease. The overall survival and clinical/pathological features between groups were similar. Of those patients receiving bilateral operations for synchronous tumours, three had bilateral RN (all before 2003), 28 (38%) had an RN followed by a PN, 10 (14%) had a PN then an RN, and 32 (44%) had bilateral PN. Over time, the proportion of patients receiving bilateral PN increased (P < 0.001); 13 of 14 patients after 2005 had bilateral PN, compared with only 34% (16 of 45) between 1995 and 2004. Forty-five patients (62%) had the larger tumour removed during the first operation. The concordance rate between tumours in a specific histological subtype was 70% (51/73), and concordance for benign vs malignant disease was 90% (66/73). Conclusion The use of PN in the management of synchronous bilateral renal masses has increased over time. The contemporary treatment of synchronous bilateral renal masses at MSKCC involves staged PN when feasible, with the more involved kidney (often larger tumour) operated on first. © 2009 BJU International.
Keywords:	controlled study; human tissue; survival rate; major clinical study; overall survival; clinical feature; histopathology; united states; follow up; tumor volume; nephrectomy; cancer center; kidney; partial nephrectomy; kidney tumor; carcinoma; malignant neoplastic disease; benign tumor; patient care planning; renal cell; urological surgery
Journal Title:	BJU International
Volume:	105
Issue:	8
ISSN:	1464-4096
Publisher:	Wiley Blackwell
Date Published:	2010-04-01
Start Page:	1093
End Page:	1097
Language:	English
DOI:	10.1111/j.1464-410X.2009.08844.x
PROVIDER:	scopus
PUBMED:	19751262
PMCID:	PMC4179200
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-77950219365&partnerID=40&md5=2655b56c477a259007e6e47e23351ee0
Notes:	--- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: BJINF" - "Source: Scopus"

https://synapse.mskcc.org/synapse/works/has_related_data_chk/4545