1860 OUTCOMES OF PATIENTS WITH SURGICALLY TREATED BILATERAL RENAL MASSES AND A MINIMUM OF 10 YEARS OF FOLLOW-UP: THE NCI EXPERIENCE

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You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111860 OUTCOMES OF PATIENTS WITH SURGICALLY TREATED BILATERAL RENAL MASSES AND A MINIMUM OF 10 YEARS OF FOLLOW-UP: THE NCI EXPERIENCE Eric A. Singer, Srinivas Vourganti, Kelly Lin, Ardeshir R. Rastinehad, Peter A. Pinto, Gopal N. Gupta, W. Marston Linehan, and Gennady Bratslavsky Eric A. SingerEric A. Singer Bethesda, MD More articles by this author , Srinivas VourgantiSrinivas Vourganti Bethesda, MD More articles by this author , Kelly LinKelly Lin Bethesda, MD More articles by this author , Ardeshir R. RastinehadArdeshir R. Rastinehad Bethesda, MD More articles by this author , Peter A. PintoPeter A. Pinto Bethesda, MD More articles by this author , Gopal N. GuptaGopal N. Gupta Bethesda, MD More articles by this author , W. Marston LinehanW. Marston Linehan Bethesda, MD More articles by this author , and Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1907AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of patients with bilateral renal masses (BRM) is challenging. While nephron-sparing surgery (NSS) has been advocated for these patients, the long-term functional and oncological outcomes are lacking. We report the outcomes of patients with BRM and a minimum of 10 years of follow-up. METHODS We queried our prospectively maintained urologic oncology database to identify patients with BRM evaluated at the National Cancer Institute who underwent their initial surgical intervention at least 10 years ago. Only those patients with documented interventions on both renal units were included in our analysis. Demographics, type of hereditary diagnosis, type and number of renal interventions, most recent renal function, presence of metastatic disease, and mortality status were recorded. Estimated GFR (eGFR) was calculated using the MDRD formula. Comparisons of renal function and overall survival between groups containing both renal units and solitary kidneys were performed using the student T-test and Kaplan-Meier analysis. P value <0.05 was considered significant. RESULTS We identified 128 patients who met our inclusion criteria. Men constituted 57% (n=73) of the sample size. Mean age at initial surgery was 38 years (17–64) and at last follow-up was 55 years (34–79). The most common hereditary diagnosis seen in our cohort was VHL (n=89, 69.5%). The median follow-up of our cohort was 16 years (10–49), mean 17 years. The median number of surgical interventions was 3 (2–10). Eighty-seven patients (68%) required repeat interventions on their ipsilateral renal unit, with a median time between interventions of 6.2 years (0.7–21). Among the 15 deaths in the cohort, 4 were due to renal cell carcinoma (RCC). Overall survival of the cohort was 88%, but RCC-specific survival was 97%. The most recent calculated median eGFR was 57 mL/min/1.73m2 (8–196). Six patients (4.7%) ultimately underwent bilateral nephrectomies. Although there was no difference in overall survival between those with bilateral or solitary kidneys (21.5 vs. 20.8 years, respectively), eGFR was better preserved in patients with both kidneys (70 vs. 53 mL/min/1.73m2, respectively; P=0.0002). CONCLUSIONS At a minimum of 10 years after initial surgery, NSS allows for excellent oncologic and functional outcomes. RCC-specific survival was 97% and greater than 95% of patients avoided the need for renal replacement therapy. Despite the need for repeat surgical interventions, preservation of both renal units appears to improve renal functional outcomes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e746 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric A. Singer Bethesda, MD More articles by this author Srinivas Vourganti Bethesda, MD More articles by this author Kelly Lin Bethesda, MD More articles by this author Ardeshir R. Rastinehad Bethesda, MD More articles by this author Peter A. Pinto Bethesda, MD More articles by this author Gopal N. Gupta Bethesda, MD More articles by this author W. Marston Linehan Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...