Surgical strategy of bilateral synchronous sporadic renal cell carcinoma-experience of a Chinese university hospital

Abstract

Background: The objective of this study is to investigate the optimal therapeutic protocol for BSSRCC.

Methods: A total of 32 BSSRCC patients, including 28 males and 4 females, were enrolled the study from January 2004 to May 2016. The diagnoses were defined by the measurements of CT, ultrasound, and MRI. Patients with hereditary syndrome were excluded. The management of surgical manner, operation staging, and sequence were scheduled in accordance with the tumor's location and size (based on Zhongshan score, ZS score), as well as the performance status of the patients. Among them, 8 cases were conducted with bilateral surgical procedure simultaneously and 24 cases were implemented with staged operations. NSS on the one side with contralateral RN, and NSS on both sides were performed in 17 and 15 patients separately.

Results: Thirty cases were conducted 56 operations in total. The average operation time was 260 ± 52 min in simultaneous operations and 162 ± 40 min in staged operations. The length of hospital stay in average was 11.5 ± 1.8 and 7.5 ± 1.4 days, respectively. Twenty-eight cases were followed up by 6-138 months. The level of creatinine was elevated in 5 cases without hemodialysis conducted.

Conclusions: The location and size of the carcinomas, and the performance status of patients should be considered in determination of an appropriate surgical approach. Both renal function preservation and tumor eradication were similarly critical, whereas the latter is of more importance. ZS score may be helpful in the dilemma. Longer follow-up period and more patient enrolment are required.

Keywords: Kidney neoplasm; Nephron-sparing surgery; Radical nephrectomy; Synchronous; ZS score.

Fig. 1

Bilateral NSS: larger tumor on the left side was dissected first

Fig. 2

Bilateral NSS: larger tumor on the left side was dissected first (Figs. 1 and 2 were of the same patient)

Fig. 3

RN on the right side first and NSS on the left thereafter at second staged surgery

Fig. 4

RN on the right side first and NSS on the left thereafter at second staged surgery (Figs. 3 and 4 were of the same patient)

Fig. 5

NSS on the left side first and RN on the right side at second staged surgey

Fig. 6

Left central renal tumor was partially resected

Fig. 7

NSS on the right side and RN on the left

Fig. 8

One year after bilateral NSS with normal renal function and no tumor recurrence could be found