Long-term outcome of multiple ipsilateral renal tumours found at the time of planned nephron-sparing surgery.
OBJECTIVE
To evaluate patients with multiple ipsilateral renal tumours and to determine outcomes of nephron-sparing surgery (NSS) and radical nephrectomy (RN), as the treatment of unrecognized sporadic multifocal tumours at NSS presents a surgical dilemma.


METHODS
In all, 104 patients had surgery between 1970 and 2003 for sporadic multiple ipsilateral renal tumours, at least one of which was renal cell carcinoma (RCC); 114 were treated with RN and 26 with NSS. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method.


RESULTS
More patients treated with NSS had a solitary kidney than those undergoing RN (six, 23%, vs none, P < 0.001). Seventeen of the 114 having RN died from RCC at a median (range) of 3.4 (0.25-10.3) years after RN. The estimated 5-year CSS was 90.5%. There was metachronous recurrence in nine patients at a median of 5.6 (1-14 ) years after. Two of the 26 patients having NSS died from RCC at 1 and 6 years after NSS; the 5-year CSS was 95.8%. There was local or metachronous recurrence in three patients at 7 months to 6 years after surgery; all three were alive at the last follow-up. In 26 (23%) of the 114 patients treated with RN, only one tumour was RCC.


CONCLUSIONS
Patients undergoing either RN or NSS for multiple ipsilateral renal tumours have a favourable CSS. A planned NSS is safe if small satellite lesions are resectable.
Krambeck
Amy
A
Urology, Mayo Clinic, Rochester, MN 55905, USA.
Iwaszko
Markian
M
Leibovich
Bradley
B
Cheville
John
J
Frank
Igor
I
Blute
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors