1488 SURGICAL TREATMENT OF BILATERAL SYNCHRONOUS KIDNEY TUMORS: LONG-TERM FUNCTIONAL AND ONCOLOGICAL OUTCOMES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 20101488 SURGICAL TREATMENT OF BILATERAL SYNCHRONOUS KIDNEY TUMORS: LONG-TERM FUNCTIONAL AND ONCOLOGICAL OUTCOMES Matthew Simmons, Ricardo Brandina, Adrian Hernandez, and Inderbir Gill Matthew SimmonsMatthew Simmons Cleveland, OH More articles by this author , Ricardo BrandinaRicardo Brandina Los Angeles, CA More articles by this author , Adrian HernandezAdrian Hernandez Cleveland, OH More articles by this author , and Inderbir GillInderbir Gill Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1204AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess renal functional and oncologic outcomes after sequential radical (RN) and/or partial nephrectomy (PN) in patients with bilateral synchronous kidneys tumors. METHODS Patients treated from June 1994-July 2008 were retrospectively analyzed. Study endpoints included MDRD2 eGFR <60ml/min/1.73m2, overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). RESULTS 220 patients were treated with sequential PN (PN-PN; n=134), PN followed by RN (PN-RN; n=60), or RN followed by PN (RN-PN; n=26). Postoperatively, cumulative eGFR decreased by 28% in the PN-PN group compared to decreases of 50% and 53% in the PN-RN and RN-PN groups, respectively (p<0.001). Tumor size <4cm and preoperative chronic kidney disease (CKD) stage ≤II correlated with favorable functional outcomes (i.e. eGFR ≥30 ml/min/1.73m2). OS for the entire cohort was 86% at 5y and 71% at 10y, which decreased to 73% at 5y, 51% at 10y for tumors >7cm. After bilateral surgery an eGFR ≤60ml/min/1.73m2 was associated with a significant decrease in OS: 5y and 10y OS was 96% and 93% for patients with CKD stage I-II vs. 80% and 70% in patients with CKD stage ≥III (p=0.02). CSS was 96% at 5y and 96% at 10y. RFS was 73% at 5y and 44% at 10y. CONCLUSIONS In patients with bilateral synchronous kidneys tumors, tumor size >4cm and pre-operative CKD stage ≥III were risk factors for CKD stage progression. Post-operative stage ≥III CKD was strongly associated with decreased 5y and 10y OS. Nephron-sparing surgery should be compulsory for all amenable kidney masses given the negative impact of renal functional decline on overall survival. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e573-e574 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Simmons Cleveland, OH More articles by this author Ricardo Brandina Los Angeles, CA More articles by this author Adrian Hernandez Cleveland, OH More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...