Bilateral renal cell carcinoma. Therapy management and histopathological results in long-term follow-up of 66 patients

Bilateral renal cell carcinoma is detected at an incidence rate of 1.6-6% o f all renal tumors. The management, histopathological results and the long- term follow-up of 66 patients with bilateral renal cell carcinoma (29 synch ronous,37 asynchronous tumors) are presented in this issue. The incidence rate of bilateral renal cell carcinoma (RCC) at our hospital was 3.5%. Nephron-sparing surgery should be used first for the smaller and favourably located tumor when radical nephrectomy of the contralateral tumo r is necessary. Thus,the patients can be spared dialysis. The histopatholog ical results showed a significantly higher incidence rate of chromophil RCC s in cases of synchronous bilateral renal tumors (36%). The 5-year survival rate was 82%. Patients with asynchronous renal cell carcinomas were significantly younger than those with synchronous RCCs (median age: 60.2 years). The histopathol ogical results were similar to unilateral renal cell carcinomas. Clear cell carcinoma was detected in 70% of cases. The 5-year survival rate was 61% a nd lower than that of synchronous tumors (82%). There was no significant di fference because of the small number of cases. Current standardised techniq ues of nephron-sparing surgery achieve good survival rates,therefore making bilateral nephrectomy only neccessary in very poor cases. In cases of chro mophil renal cell carcinomas,the contralateral kidney should always be care fully examined, because these tumors were significantly more often detected to be bilateral. The risk of also developing a tumor in the contralateral kidney increases with decreasing age at first manifestation (<55 years, 6%) . Especially in those younger than 55 years, partial nephrectomy seems to b e recommended for unilateral renal tumors in patients with a normal contral ateral kidney (tumor size <4 cm in diameter).