Management and extended outcome of patients with synchronous bilateral solid renal neoplasms in the absence of von Hippel-Lindau disease

Objective: To gain information regarding long-term follow-up in patients wi th synchronous bilateral solid renal neoplasms in whom renal preserving sur gery is imperative. Patients and Methods: We examined our surgical experience and the survival outcome, as evaluated by Kaplan-Meier and log-rank analysis, of 94 patients (64 men and 30 women) who presented to the Mayo Clinic in Rochester, Minn, from 1973 to 1998 with bilateral synchronous solid renal neoplasms in the absence of von Hippel-Lindau disease. Follow-up of these patients ranged fr om 1 to 25 years, with a mean of 5.86 years and a median of 4.18 years. Tum ors were staged according to the TNM classification. Pathologic staging and grading were usually performed on the kidney with the most extensive cance r. The Cox proportional hazards model was used to assess the relationship o f grade (1-4), tumor size, and enucleation as opposed to extended (1 cm) pa rtial nephrectomy on overall, cancer-specific, local recurrence-free, and m etastasis-free survival. Results: Seventy-one patients (76%) had bilateral synchronous renal cell ca rcinoma, and 14 patients (15%) had a unilateral renal cell carcinoma with a contralateral benign solid neoplasm. Nine patients (10%) had bilateral ben ign solid lesions. Sixty-six patients (70%) underwent a single procedure, w hereas 28 (30%) underwent staged surgical procedures. Fifty-one patients (5 4%) are alive, and 43 (46%) have died. Twenty patients (21%) died of metast atic disease, and 5 (5%) had a local recurrence. Cancer-specific survival o f the 85 patients with at least 1 renal cell carcinoma still under observat ion was 81% (+/-4.9% SE) and 59% (+/-8.1% SE) at 5 and 10 years, respective ly, and survival to local recurrence was 96% (+/-2.6% SE) at 5 years and 93 % (+/-3.7% SE) at 10 years with 14 patients still under observation. Grade 3 was a statistically significant factor for metastasis (P<.001). A signifi cant difference in metastasis-free survival and cancer-specific survival wa s noted dependent on pathologic T stage (P<.001 and P=.02, respectively), w ith patients with local pT3 disease having a higher rate of metastasis and cancer-specific death. Multivariate analysis revealed that tumor grade was associated with metastasis-free survival (P=.002) and tumor size with cance r-specific survival (P=.04). There was no statistical significance on survi val outcome end points according to procedure performed, ie, enucleation vs extended partial nephrectomy. Conclusion: Long-term results of renal-preserving procedures for a series o f patients with bilateral solid renal neoplasms indicate that grade, stage, and tumor size are significant predictors of outcome. Mean follow up of ov er 5 years supports nephron-sparing techniques in selected patients because local recurrence was infrequent compared with distant metastasis.