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The current evidence on surgical management for synchronous bilateral renal tumors: results from a scoping review
Carlo Giulioni1, Martina Maggi2, Giacomo Maria Pirola3
1Urology Unit, Department of Urology, Azienda Ospedaliero-Universitaria Delle Marche, Polytechnic University of Marche, 71 Conca Street, 60126, Ancona, Italy. carlo.giulioni9@gmail.com.
Purpose:
Synchronous bilateral renal masses (SBRM) account for a low percentage of kidney tumors, and there is no current recommendation for their management. The objective was to review evidence regarding the best surgical approach for SBRM in terms of type and timing of surgery.
Methods:
A broad literature search was performed on 28th January 2023 using Scopus, PubMed, and EMBASE. Only English papers dealing with adults were included. Meeting abstracts were excluded.
Results:
Twenty-four papers were accepted and included. SBRM behave less aggressively than metachronous tumors, and partial nephrectomy (PN) is the preferred therapeutic option to preserve renal function. Open, laparoscopic, and robot-assisted approaches were found to be similar in oncological outcomes, though robot-assisted surgery resulted in lower comorbidities. Same-sitting PN was demonstrated to be a safe approach, particularly in the robotic-assisted one. Finally, the same-siting and staged NSS were similar in preserving renal function.
Conclusions:
PN should be the desirable treatment for SBRM whenever feasible and if patients are fit, but surgeon expertise should also be taken into the account.
Insights
For synchronous bilateral renal masses (SBRM), partial nephrectomy (PN) is the preferred surgical approach. Robot-assisted surgery offers lower comorbidities, and same-sitting PN is a safe option, preserving renal function.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Synchronous bilateral renal masses (SBRM) are rare kidney tumors with no established management guidelines.
- Optimal surgical strategy for SBRM requires careful consideration of tumor characteristics and patient factors.
Purpose of the Study:
- To review existing evidence on the optimal surgical approach for SBRM.
- To compare different surgical techniques and timings for managing SBRM.
Main Methods:
- Comprehensive literature search conducted in January 2023 across Scopus, PubMed, and EMBASE.
- Inclusion criteria: English-language studies on adult patients; exclusion of meeting abstracts.
- Analysis of 24 selected papers on SBRM management.
Main Results:
- SBRM exhibit less aggressive behavior compared to metachronous tumors.
- Partial nephrectomy (PN) is the preferred option for preserving renal function.
- Oncological outcomes are comparable across open, laparoscopic, and robot-assisted PN; robot-assisted surgery shows fewer comorbidities.
- Same-sitting PN, especially robot-assisted, is a safe approach.
- Same-sitting and staged nephron-sparing surgery (NSS) demonstrate similar renal function preservation.
Conclusions:
- Partial nephrectomy (PN) is the recommended treatment for SBRM when feasible and patient condition permits.
- Surgeon expertise is a critical factor in selecting the surgical approach for SBRM.
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