Presentation Authors: Vignesh T. Packiam, Matvey Tsivian*, Christine M. Lohse, John C. Cheville, Stephen A. Boorjian, R. Houston Thompson, Bradley C. Leibovich, Rochester, MN
Introduction: The optimal surgical management for bilateral synchronous solid renal masses is controversial, particularly regarding the performance of bilateral partial nephrectomy (PNx) in a single setting. We evaluated the impact of simultaneous vs staged bilateral PNx on renal function, complication rates, and survival outcomes using a large institutional cohort.
Methods: We retrospectively reviewed our institutional nephrectomy registry to identify 107 patients with non-metastatic bilateral synchronous solid renal masses managed with simultaneous or staged bilateral PNx performed within 6 months of each other between 1980 and 2015. Following the simultaneous or second staged surgery, short-term and long-term renal function changes were assessed at 3 and 12 months, respectively. Peri-operative outcomes were pooled across the staged surgeries by taking the sum of each outcome. Renal functional, peri-operative, and oncologic outcomes were compared by surgical approach.
Results: Among the 107 patients studied, 77 (72%) underwent simultaneous and 30 (28%) underwent staged PNx. Median follow-up among survivors was 9.2 (IQR 5.6-13.1) years, during which time 34 died, including 10 from RCC. At diagnosis, mean age was 60 years, mean eGFR was 68 ml/min, and mean largest tumor size was 5.3 cm. There were no significant differences in clinicopathologic features between groups apart from lower BMI (mean 29 vs 32, p=0.022) in patients managed with simultaneous vs staged approach. Patients treated with a simultaneous approach had lower short-term (6% vs 24%, p=0.015) and long-term (4% vs 22%, p < 0.001) reduction in eGFR. The only differences in peri-operative outcomes between simultaneous PNx and pooled rates from first and second staged PNx were lower length of stay (median 6 vs 8 days, p < 0.001), lower rate of urine leak (3% vs 17%, p=0.018), and lower rate of high (Clavien 3 or 4) complications (8% vs 23%, p=0.044), respectively (Table 1). There were no significant differences in local recurrence, distant metastases, death from RCC, or death from any cause between groups.
Conclusions: Our results suggest that when technically feasible, simultaneous bilateral PNx offers favorable outcomes vs staged PNx, and is a reasonable treatment option for patients presenting with bilateral synchronous solid renal masses.