Clinical Research Of The Nephron-sparing Surgery For Bilateral Renal Cell Carcinoma

Renal cell carcinoma is a common urinary malignant tumor. The incidence of this tumor is just below the bladder tumor. Bilateral renal cell carcinoma is 1%～4% of these. The traditional treatment is radical nephrectomy, but after that the patient must live by dialysis or kidney transplant. As the imageology technology improved, more and more early stage and sporadic renal carcinoma have been found. The nephron-Sparing surgery has gained unprecedented attention. Clinical studies showed that the Survival rate and tumor recurrence rate was no significant difference between the new pattern and the old one. Furthermore, this operation had little influence to the patients' renal function. Although there were few interrelated studies in china yet, and most of them were case reports or small sample sized, the preliminary predicate it was safe and effective. We had long term follow up after they discharged.Objective:To evaluate the efficacy and safety of the nephron-Sparing surgery for the patients with bilateral renal cell carcinoma. Methods:From Jan, 1991 to Dec, 2006, 23 cases of bilateral renal cell carcinoma were treated in our hospital. This series included 14 male and 9 female with the average age was51.6. 19 of them had undergone the nephron-Sparing surgery. After that, we monitored the blood pressure, serum creatinine, blood urea nitrogen and protein in urine within two weeks. To evaluation the recurrence and metastasis by rechecking the B-wave ultrasound, computerized tomography and sternum. Result:All the patients were followed up for 3 months to 24 years (mean 3.4 years). 4 cases died, 3 cases died of tumor metastasis, 1 case died of cerebral accident. 1 case had metastasis on the upper lobe of the left lung but still alive. 1 case had local recurrence but alive. The rest were surviving without any tumor recurrence or metastasis during the follow up period. The renal function could sustain the life, and simultaneously no change of serum creatinine, urea nitrogen or albuminuria. The patient had undergone radical resection of asynchronous renal cell carcinoma appeared tumor on contralateral kidney 7 months to 18 years later. The longest survival time after the surgery treatment in the patient with synchronous renal cell carcinoma was 25 years. Conclusions:The patient with the bilateral renal cell carcinoma should not be restricted to the surgery absolutely. The nephron sparing surgery is a safe and reasonable method at present. The prognosis of the carcinoma relate to the stage and grade. It is no difference between the bilateral renal cell carcinoma and the single one.