Long-term outcome of multiple ipsilateral renal tumours found at the time of planned nephron-sparing surgery

Authors


Michael Blute, Mayo Clinic – Urology, 200 First Street SW, Rochester, MN 55905, USA.
e-mail: blute.michael@mayo.edu

Abstract

OBJECTIVE

To evaluate patients with multiple ipsilateral renal tumours and to determine outcomes of nephron-sparing surgery (NSS) and radical nephrectomy (RN), as the treatment of unrecognized sporadic multifocal tumours at NSS presents a surgical dilemma.

PATIENTS AND METHODS

In all, 104 patients had surgery between 1970 and 2003 for sporadic multiple ipsilateral renal tumours, at least one of which was renal cell carcinoma (RCC); 114 were treated with RN and 26 with NSS. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method.

RESULTS

More patients treated with NSS had a solitary kidney than those undergoing RN (six, 23%, vs none, P < 0.001). Seventeen of the 114 having RN died from RCC at a median (range) of 3.4 (0.25–10.3) years after RN. The estimated 5-year CSS was 90.5%. There was metachronous recurrence in nine patients at a median of 5.6 (1–14 ) years after. Two of the 26 patients having NSS died from RCC at 1 and 6 years after NSS; the 5-year CSS was 95.8%. There was local or metachronous recurrence in three patients at 7 months to 6 years after surgery; all three were alive at the last follow-up. In 26 (23%) of the 114 patients treated with RN, only one tumour was RCC.

CONCLUSION

Patients undergoing either RN or NSS for multiple ipsilateral renal tumours have a favourable CSS. A planned NSS is safe if small satellite lesions are resectable.

Ancillary