Contemporary strategies for treating nonhereditary synchronous bilateral renal tumors and the impact of minimally invasive, nephron-sparing techniques

Objectives: As surgical technology and expertise advance, treatment strategies for patients with bilateral renal tumors will continue to shift toward methods that maximize preservation of renal function and maintain optimal oncologic outcomes while minimizing morbidity. Reports about such strategies are limited. We report the outcome of a contemporary cohort of patients treated for nonhereditary synchronous bilateral renal tumors at our institution to evaluate surgical strategies and newer techniques used during patient treatment. Methods: From a surgical database, we identified 43 patients who met the criteria for nonhereditary, synchronous, bilateral renal tumors. Demographic characteristics, tumor pathology, renal function, surgical data, and outcomes were extracted from each patient's medical record. Computerized literature searches were performed to identify related articles for comparative purposes. Results: Of the 43 patients, 36 (82%) were treated with staged procedures a median of 54 days apart. A total of 23 patients (53.3%) received bilateral nephron-sparing therapy, of whom 11 underwent a minimally invasive nephron-sparing approach. There was a median 28.0 ml/min decrease in creatinine clearance between initial preoperative levels and at last follow-up, with a median follow-up duration of 16 months, and no patient required dialysis. Of the 43 patients, 2 (4.7%) had local recurrences, and 1 (2.3%) had metastatic disease. Conclusion: These findings show a contemporary standard of care for treating patients with bilateral renal tumors, with more than half the patients undergoing bilateral nephron-sparing and nearly one third of patients receiving a minimally invasive nephron-sparing approach.