Surgical Management of Synchronous, Bilateral Renal Masses: A 1-decade Referral Center Experience

Background: Management and decision-making in patients with bilateral renal masses are controversial.Objective: To report our experience of surgical management in patients with bilateral renal masses undergoing surgery at a high-volume center.Design, setting, and participants: We retrospectively collected data from patients trea-ted with partial nephrectomy (PN) or radical nephrectomy for bilateral renal masses at a single referral institution between June 2008 and June 2019. Patient-and tumor -related features, timing (one vs two stage), and surgical approach (open vs robotic) were analyzed.Surgical procedure: A one-versus two-stage strategy was adopted according to the opportunity to perform at least one PN using a clampless or selective-clamping approach, in order to avoid acute kidney injury.Measurements: Operative time, warm ischemia time, and intra-and postoperative com-plications were recorded. Histopathological results and tumor histology were assessed.Results and limitations: Overall, 41 patients were included. The median age was 67 yr and the median preoperative estimated glomerular filtration rate (eGFR) was 84 ml/min/1.73 m2. The median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (interquartile range [IQR] 7-8) for both sides. In 17 (42%) patients, a simultaneous approach was chosen, with a pure robotic approach in 11/17 cases, while among the 24 (58.6%) patients treated with a two-stage strategy, 15 (62.5%) were treated with a robotic approach on both sides. Intraoperative complica-tions and postoperative major (CDC >= 3) complications were recorded in 7.3% and 4.9% of cases, respectively. The overall positive surgical margins rate was 2.4%. At a median follow-up of 42 (IQR 18-59) mo, the median eGFR was 73 (IQR 64-80) ml/min/1.73 m2, while disease-free survival and cancer-specific mortality were 90.2% and 7.3%, respectively.Conclusions: Our experience underlines that both simultaneous and staged surgical treatment of patients with bilateral renal masses are feasible and safe if grounded on proper patient selection.