Evaluation of functional outcome of bilateral kidney tumors after sequential surgery

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dc.contributor.authorKim, Jung Kwon-
dc.contributor.authorKim, Hwanik-
dc.contributor.authorLee, Hakmin-
dc.contributor.authorOh, Jong Jin-
dc.contributor.authorLee, Sangchul-
dc.contributor.authorHong, Sung Kyu-
dc.contributor.authorKwak, Cheol-
dc.contributor.authorByun, Seok-Soo-
dc.identifier.citationBMC Cancer. 2021 May 24;21(1):592ko_KR
There are limited data concerning patients treated with sequential bilateral kidney surgery. Current guidelines still lack an optimal surgical sequencing approach. We evaluated renal functional outcomes after sequential partial nephrectomy (PN) and radical nephrectomy (RN) in patients with bilateral renal cell carcinoma (RCC).

A propensity score matched cohort of 267 patients (synchronous bilateral RCCs, N = 44 [88 lesions]; metachronous bilateral, N = 45 [90 lesions]; unilateral, N = 178) from two tertiary institutions were retrospectively analyzed. Synchronous bilateral RCCs were defined as diagnosis concomitantly or within 3 months of former tumor. Renal functional outcomes were defined as estimated glomerular filtration rate (eGFR) changes and de novo chronic kidney disease (CKD, stage ≥3) after surgery. Renal functional outcomes and clinical factors predicting de novo CKD were assessed using descriptive statistics and Cox regression analysis.

In subgroup of bilateral RCCs, patients underwent sequential PN (N = 48), PN followed by RN (N = 8), or RN followed by PN (N = 25). Final postoperative estimated glomerular filtration rates (eGFRs) were 79.4, 41.4, and 61.2 ml/minute/1.73 m2, respectively (p = 0.003). There were significant differences in eGFR decline from baseline and de novo chronic kidney disease (CKD stage ≥ III) among groups, with PN followed by RN group showing the worst functional outcomes (all p <  0.05). Moreover, sequential PN subgroup in bilateral RCC showed significantly higher rate of de novo CKD than unilateral RCC group (13.8% vs. 6.9%, p = 0.016). On multivariate analysis, hypertension (p = 0.010) and surgery sequence (PN followed by RN, p <  0.001) were significant predictors of de novo CKD.

The surgery sequence should be prudently determined in bilateral renal tumors. PN followed by RN showed a negative impact on renal functional preservation. Nephron-sparing surgery should be considered for all amenable bilateral RCCs.
dc.subjectFunctional outcomes-
dc.subjectRenal cell carcinoma-
dc.subjectPartial nephrectomy-
dc.subjectSequence of surgery-
dc.titleEvaluation of functional outcome of bilateral kidney tumors after sequential surgeryko_KR
dc.citation.journaltitleBMC Cancerko_KR
dc.rights.holderThe Author(s)-
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College of Medicine/School of Medicine (의과대학/대학원)Urology (비뇨기과학전공)Journal Papers (저널논문_비뇨기과학전공)
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