Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue SL-42, New Orleans, LA 70112, USA.
Int Urol Nephrol. 2013 Jun;45(3):619-25. doi: 10.1007/s11255-013-0414-2. Epub 2013 Mar 26.
To review the intermediate term oncologic and functional outcomes after the surgical management of bilateral renal masses (BRM).
After obtaining Institutional Review Board approval, the Tulane renal surgery database (n = 890 patients) was queried for patients presenting with synchronous bilateral enhancing renal masses (n = 30 renal units). We performed a retrospective chart review evaluating oncologic and functional outcomes, specifically with respect to local recurrence and metastatic disease. We also reviewed changes in glomerular filtration rates.
Of the 30 renal units were operated on for BRM concerning for renal cell carcinoma, 25 kidneys harbored malignancy (83.3 %). The average tumor size was 3.35 cm. Treatment of each kidney was staged; average time period to treatment of contralateral side was 3.5 months. Estimated GFR (eGFR) for these same pre-operative patients was 59 ml/min/1.73 m(2) (range 25-89). The average creatinine after treatment of one kidney was available for all patients and was 1.5 (range 0.7-2.8), with an average eGFR of 51.8 (range 29-87). The average creatinine after the second operation for these same 15 patients was 1.79 (range 0.9-3.7) with an average GFR of 41.9 (range 17-78). No patient had to undergo temporary dialysis. An average change in GFR after the second, contralateral procedure on the kidney was 17.07 mg/dl. Average oncologic follow-up was 608 days. Excluding two patients who presented with metastatic disease, the average recurrence-free survival was 92.8 %.
Our data continue to underscore the need for nephron sparing surgery (NSS), especially in the setting of BRM. The average decline in GFR of 28.9 % after treatment of both kidneys and renal cell carcinoma recurrence-free rate of 92.3 % further support the efficacy of NSS in these patients.
回顾双侧肾脏肿块（BRM）手术治疗后的中期肿瘤学和功能结果。
在获得机构审查委员会批准后，我们查询了杜兰肾脏手术数据库（n = 890 例患者），以查找同时存在双侧增强性肾肿块（n = 30 个肾脏单位）的患者。我们进行了回顾性图表审查，评估了肿瘤学和功能结果，特别是局部复发和转移性疾病。我们还审查了肾小球滤过率的变化。
在因肾细胞癌而行 BRM 手术的 30 个肾脏单位中，25 个肾脏存在恶性肿瘤（83.3%）。肿瘤平均大小为 3.35cm。对每个肾脏的治疗进行分期；对侧治疗的平均时间间隔为 3.5 个月。这些相同术前患者的估计肾小球滤过率（eGFR）为 59ml/min/1.73m²（范围 25-89）。所有患者均提供了单侧治疗后平均肌酐值，为 1.5（范围 0.7-2.8），平均 eGFR 为 51.8（范围 29-87）。对于这些相同的 15 名患者的第二次手术，平均肌酐值为 1.79（范围 0.9-3.7），平均 GFR 为 41.9（范围 17-78）。没有患者需要进行临时透析。第二次手术后肾脏的平均 GFR 变化为 17.07mg/dl。平均肿瘤学随访时间为 608 天。排除两名患有转移性疾病的患者后，平均无复发生存率为 92.8%。
我们的数据继续强调需要进行保肾手术（NSS），特别是在存在 BRM 的情况下。双侧肾脏和肾细胞癌治疗后平均 GFR 下降 28.9%，以及无复发生存率为 92.3%，进一步支持了 NSS 在这些患者中的疗效。
