Contemporary management of renal cell carcinoma with coexistent renal artery disease: Update of the Cleveland Clinic experience

Objectives. To treat concurrent renal cell carcinoma (RCC) and renal artery disease (RAD), which pose an unusual and challenging management dilemma. Methods. Before June 1998, 48 patients presented with localized RCC and RAD affecting all the functioning renal parenchyma. These patients were groupe d into four distinct categories: group 1, a solitary kidney with RCC and RA D (n = 8); group 2, bilateral RCC and coexistent RAD (n = 9); group 3, unil ateral RCC and contralateral RAD (n = 15); and group 4, unilateral RCC and bilateral RAD (n = 16). The most common cause of RAD was atherosclerosis (n = 40), followed by medial fibroplasia (n = 5), renal artery aneurysm (n = 2), and arteriovenous malformation (n = 1). Results. All patients underwent complete surgical excision of RCC. A nephro n-sparing operation was performed preferentially (44 patients), and bilater al renal cancer operations were staged. Eleven patients underwent surgical renal vascular reconstruction in conjunction with either partial (n = 9) or radical (n = 2) nephrectomy. In 2 patients, renal revascularization was ac complished by percutaneous transluminal angioplasty before tumor excision. No perioperative deaths occurred. Postoperatively, preservation of renal fu nction was achieved in 47 patients; 1 patient required chronic dialysis. Th e overall and cancer-specific 5-year patient survival rates in this series were 66% and 90%, respectively. At a mean follow-up of 58 months, 28 patien ts were alive with no evidence of malignancy. Six patients died of metastat ic RCC, and 14 died of unrelated causes with no evidence of malignancy. Conclusions. Nephron-sparing surgery combined with selective renal arterial reconstruction can yield gratifying results in this complex patient popula tion. UROLOGY 56: 382-386, 2000. (C) 2000, Elsevier Science Inc.