Experience in diagnosis and treatment of non-hereditary bilateral synchronous renal carcinoma

Abstract

Objective To investigate the principles of diagnosis and treatment of non-hereditary bilateral synchronous renal cell carcinoma. Methods This retrospective study analyzed 36 cases of non-hereditary bilateral synchronous renal cell carcinoma in our hospital from January 2008 to December 2016, including 30 males and 6 females. A total of 74 renal tumors were found, in which 34 patients had bilateral single kidney tumor and 2 patients had two tumors in one kidney. The diameter of tumors ranged from 1cm to 11 cm, with an average of (6.8±4.1)cm. The patients that underwent nephron-sparing surgery(NSS) got 4-12 points, with an average of (6.1±3.4) points in R. E.N.A.L. score and 3-13 points, with an average of (6.9±3.7) points in Zhongshan score. The patients are classified into 4 groups according to operation methods. In group A, 16 patients underwent bilateral NSS, which the preoperative creatinine was 63-103 μmol/L with an average of (80.9±11.4)μmol/L. In group B, 7 patients underwent one side of NSS before contralateral radical nephrectomy (RN), which preoperative creatinine was 59-87 μmol/L with an average of (75.7±8.9)μmol/L. In group C, 7 patients underwent one side of RN before contralateral NSS, preoperative creatinine was 57-107 μmol/L, with an average of (77.6±19.2)μmol/L. In group D, 6 patients underwent one side of NSS or RN and spare the contralateral side, 2 of which shifted from NSS to RN after finding tumor invaded pelvis and upper ureter during surgery. Of all the 16 patients with bilateral NSS, 4 patients underwent surgery on the side where tumor had a higher score in the first phase and then the side where tumor had a lower score in the second phase, 11 underwent surgeries in an opposite order. One patient underwent bilateral NSS simultaneously. Group A, B and C are taken into final analysis. Result All the 30 patients underwent surgery successfully. The operation time of NSS ranged from 60 to 110 min with an average of (88.6±23.6)min and RN ranged from 40 to 90 min with an average of (72.3±21.4)min. The warm ischemia time of NSS was 12-40 mins with an average of (29.5±9.7)min. The creatinine of Group A was 62-117 μmol/L with an average of (89.4±15.8)μmol/L and 57-392 μmol/L with an average of (129.6±74.9)μmol/L one month after the first and second surgery respectively. The creatinine of Group B was 64-115 μmol/L with an average of (94±14.4)μmol/L and 93-453 μmol/L with an average of (190.4±117.2)μmol/L one month after the first and second surgery respectively. The creatinine of Group C was 84-113 μmol/L with an average of (90.1±12.1)μmol /L and 88-156 μmol/L with an average of (121.4±24.8)μmol/L one month after the first and second surgery respectively. One patient in Group B and C developed lung metastases. One patient in Group B occurred oliguria after the second stage of surgery, and gradually improved after one week of hemodialysis. The creatine showed no significant difference among Group A, B and C before operation, after the first and second stage(P>0.05). Postoperative hospital stay after the first stage surgery was 3-16 days with an average of (6.7±3.4)d, and 3-16 d with an average of (6.2±3.2)d after the second stage, respectively. Conclusions In principle, bilateral renal tumors should be treated with NSS, which can protect renal functions as much as possible. Among patients who can undergo bilateral NSS, the first-stage surgery should be operated on the simpler and easier side to preserve the kidney of one side as much as possible to lay a good foundation for the second stage surgery. Among patients who undergo one side of RN and the other side of NSS, NSS is recommended for the first stage, and RN for the contralateral second stage after the renal function of the operated side was restored. Key words: Renal carcinoma; Surgery; Nephron-sparing surgery