Abstract:

Objective To evaluate the long-term outcomes of surgical treatment on patients with synchronous sporadic and non-metastatic bilateral renal cell carcinoma（BRCC）. Methods In this retrospective study， 16 patients with synchronous sporadic and nonmetastatic BBRC were enrolled from 2000 to 2010. All patients underwent staged surgical procedures， including nephron-sparing surgery（NSS） and radical nephrectomy（RN）. According to the treatment protocol， 16 patients were assigned into unilateral RN followed by contralateral NSS（RN+NSS group， n=5）， unilateral NSS followed by contralateral RN（NSS+RN group， n=8） or bilateral NSS（NSS+NSS group， n=3）. The longterm oncological outcome and renal function were analyzed. Results A total of 33 renal tumors were found in the 16 patients， including T1a19 tumors（57.6％）， T1b 10 tumors（30.3％）， T2a 3 tumors（9.0％） and T3a 1 tumor（3.0％）. The incidence of acute renal failure in RN+NSS group， NSS+RN group and NSS+NSS group were 80.0％， 25.0％ and 0（P=0.028）， respectively. None of the patients required temporary or permanent dialysis. The 3-， 5-year disease-free survival rates were 93.8％ and 87.5％， and the corresponding overall survival rates were 100％ and 100％， respectively. Conclusion Staged surgical procedures are safe and efficient in the treatment of patients with synchronous sporadic and non-metastatic BBRC， resulting in the preservation of renal function and long-term cancer control. Our strategy was in general to first attempt NSS of the more favorable tumor， followed by NSS or RN of the less favorable contralateral tumor within 6 weeks. This approach allows the patient to recover from possible acute renal failure after NSS.