Developments in the surgical management of sporadic synchronous bilateral renal tumours

William T. Lowrance, David S. Yee, Alexandra C. Maschino, Angel M. Cronin, Melanie Bernstein, R. Houston Thompson, Paul Russo

Research output: Contribution to journalArticle

Abstract

Objective To examine our experience with managing sporadic bilateral renal masses, focusing on trends in surgical management over time, because as loss of renal function is associated with adverse cardiovascular outcomes, nephron-sparing approaches are increasingly emphasized in the treatment of kidney tumours, creating new challenges for the treatment of bilateral tumours. Patients and Methods We identified all patients who underwent partial or radical nephrectomy (PN or RN) at Memorial Sloan-Kettering Cancer Center (MSKCC) during 1989-2008. We compared patients presenting with synchronous bilateral renal masses with those with unilateral tumour and evaluated trends in management using logistic regression. Results Of the 2777 patients studied, 73 (3%) presented with synchronous bilateral disease. The overall survival and clinical/pathological features between groups were similar. Of those patients receiving bilateral operations for synchronous tumours, three had bilateral RN (all before 2003), 28 (38%) had an RN followed by a PN, 10 (14%) had a PN then an RN, and 32 (44%) had bilateral PN. Over time, the proportion of patients receiving bilateral PN increased (P <0.001); 13 of 14 patients after 2005 had bilateral PN, compared with only 34% (16 of 45) between 1995 and 2004. Forty-five patients (62%) had the larger tumour removed during the first operation. The concordance rate between tumours in a specific histological subtype was 70% (51/73), and concordance for benign vs malignant disease was 90% (66/73). Conclusion The use of PN in the management of synchronous bilateral renal masses has increased over time. The contemporary treatment of synchronous bilateral renal masses at MSKCC involves staged PN when feasible, with the more involved kidney (often larger tumour) operated on first.

Original languageEnglish (US)
Pages (from-to)1093-1097
Number of pages5
JournalBJU International
Volume105
Issue number8
DOIs
StatePublished - Apr 2010
Externally publishedYes

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Kidney
Neoplasms
Time Management
Nephrons
Nephrectomy
Therapeutics
Logistic Models
Survival

Keywords

  • Carcinoma
  • Kidney
  • Nephrectomy
  • Renal cell
  • Urological surgery

ASJC Scopus subject areas

  • Urology

Cite this

Lowrance, W. T., Yee, D. S., Maschino, A. C., Cronin, A. M., Bernstein, M., Thompson, R. H., & Russo, P. (2010). Developments in the surgical management of sporadic synchronous bilateral renal tumours. BJU International, 105(8), 1093-1097. https://doi.org/10.1111/j.1464-410X.2009.08844.x

Developments in the surgical management of sporadic synchronous bilateral renal tumours. / Lowrance, William T.; Yee, David S.; Maschino, Alexandra C.; Cronin, Angel M.; Bernstein, Melanie; Thompson, R. Houston; Russo, Paul.

In: BJU International, Vol. 105, No. 8, 04.2010, p. 1093-1097.

Research output: Contribution to journalArticle

Lowrance, WT, Yee, DS, Maschino, AC, Cronin, AM, Bernstein, M, Thompson, RH & Russo, P 2010, 'Developments in the surgical management of sporadic synchronous bilateral renal tumours', BJU International, vol. 105, no. 8, pp. 1093-1097. https://doi.org/10.1111/j.1464-410X.2009.08844.x
Lowrance WT, Yee DS, Maschino AC, Cronin AM, Bernstein M, Thompson RH et al. Developments in the surgical management of sporadic synchronous bilateral renal tumours. BJU International. 2010 Apr;105(8):1093-1097. https://doi.org/10.1111/j.1464-410X.2009.08844.x
Lowrance, William T. ; Yee, David S. ; Maschino, Alexandra C. ; Cronin, Angel M. ; Bernstein, Melanie ; Thompson, R. Houston ; Russo, Paul. / Developments in the surgical management of sporadic synchronous bilateral renal tumours. In: BJU International. 2010 ; Vol. 105, No. 8. pp. 1093-1097.
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abstract = "Objective To examine our experience with managing sporadic bilateral renal masses, focusing on trends in surgical management over time, because as loss of renal function is associated with adverse cardiovascular outcomes, nephron-sparing approaches are increasingly emphasized in the treatment of kidney tumours, creating new challenges for the treatment of bilateral tumours. Patients and Methods We identified all patients who underwent partial or radical nephrectomy (PN or RN) at Memorial Sloan-Kettering Cancer Center (MSKCC) during 1989-2008. We compared patients presenting with synchronous bilateral renal masses with those with unilateral tumour and evaluated trends in management using logistic regression. Results Of the 2777 patients studied, 73 (3{\%}) presented with synchronous bilateral disease. The overall survival and clinical/pathological features between groups were similar. Of those patients receiving bilateral operations for synchronous tumours, three had bilateral RN (all before 2003), 28 (38{\%}) had an RN followed by a PN, 10 (14{\%}) had a PN then an RN, and 32 (44{\%}) had bilateral PN. Over time, the proportion of patients receiving bilateral PN increased (P <0.001); 13 of 14 patients after 2005 had bilateral PN, compared with only 34{\%} (16 of 45) between 1995 and 2004. Forty-five patients (62{\%}) had the larger tumour removed during the first operation. The concordance rate between tumours in a specific histological subtype was 70{\%} (51/73), and concordance for benign vs malignant disease was 90{\%} (66/73). Conclusion The use of PN in the management of synchronous bilateral renal masses has increased over time. The contemporary treatment of synchronous bilateral renal masses at MSKCC involves staged PN when feasible, with the more involved kidney (often larger tumour) operated on first.",
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AU - Thompson, R. Houston

AU - Russo, Paul

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N2 - Objective To examine our experience with managing sporadic bilateral renal masses, focusing on trends in surgical management over time, because as loss of renal function is associated with adverse cardiovascular outcomes, nephron-sparing approaches are increasingly emphasized in the treatment of kidney tumours, creating new challenges for the treatment of bilateral tumours. Patients and Methods We identified all patients who underwent partial or radical nephrectomy (PN or RN) at Memorial Sloan-Kettering Cancer Center (MSKCC) during 1989-2008. We compared patients presenting with synchronous bilateral renal masses with those with unilateral tumour and evaluated trends in management using logistic regression. Results Of the 2777 patients studied, 73 (3%) presented with synchronous bilateral disease. The overall survival and clinical/pathological features between groups were similar. Of those patients receiving bilateral operations for synchronous tumours, three had bilateral RN (all before 2003), 28 (38%) had an RN followed by a PN, 10 (14%) had a PN then an RN, and 32 (44%) had bilateral PN. Over time, the proportion of patients receiving bilateral PN increased (P <0.001); 13 of 14 patients after 2005 had bilateral PN, compared with only 34% (16 of 45) between 1995 and 2004. Forty-five patients (62%) had the larger tumour removed during the first operation. The concordance rate between tumours in a specific histological subtype was 70% (51/73), and concordance for benign vs malignant disease was 90% (66/73). Conclusion The use of PN in the management of synchronous bilateral renal masses has increased over time. The contemporary treatment of synchronous bilateral renal masses at MSKCC involves staged PN when feasible, with the more involved kidney (often larger tumour) operated on first.

AB - Objective To examine our experience with managing sporadic bilateral renal masses, focusing on trends in surgical management over time, because as loss of renal function is associated with adverse cardiovascular outcomes, nephron-sparing approaches are increasingly emphasized in the treatment of kidney tumours, creating new challenges for the treatment of bilateral tumours. Patients and Methods We identified all patients who underwent partial or radical nephrectomy (PN or RN) at Memorial Sloan-Kettering Cancer Center (MSKCC) during 1989-2008. We compared patients presenting with synchronous bilateral renal masses with those with unilateral tumour and evaluated trends in management using logistic regression. Results Of the 2777 patients studied, 73 (3%) presented with synchronous bilateral disease. The overall survival and clinical/pathological features between groups were similar. Of those patients receiving bilateral operations for synchronous tumours, three had bilateral RN (all before 2003), 28 (38%) had an RN followed by a PN, 10 (14%) had a PN then an RN, and 32 (44%) had bilateral PN. Over time, the proportion of patients receiving bilateral PN increased (P <0.001); 13 of 14 patients after 2005 had bilateral PN, compared with only 34% (16 of 45) between 1995 and 2004. Forty-five patients (62%) had the larger tumour removed during the first operation. The concordance rate between tumours in a specific histological subtype was 70% (51/73), and concordance for benign vs malignant disease was 90% (66/73). Conclusion The use of PN in the management of synchronous bilateral renal masses has increased over time. The contemporary treatment of synchronous bilateral renal masses at MSKCC involves staged PN when feasible, with the more involved kidney (often larger tumour) operated on first.

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