Possible treatments for synchronous bilateral small renal masses
0 
, Abstract
Currently, there is no established consensus on the best treatment approach for patients with bilateral synchronous renal masses (BSRM). The timing and method of managing these cases remain subjects of debate. This review aims to summarize the available literature and explore the ongoing controversies surrounding this topic. Three studies investigated non-surgical treatments within BSRM. Specifically, one study focused on active surveillance (AS) and showed no statistical differences in terms of progression and development of metastatic disease relative to their unilateral counterpart. Two studies investigated ablative techniques showing promising results. Eight papers have been published regarding robot assisted partial nephrectomy (RAPN) for BSRM. All these papers highlighted the safety, feasibility, and efficacy of bilateral RAPN for BSRM. Literature regarding treatments other than surgery such as AS and ablative therapies (ATs) for BSRM is scarce, but promising. Progression, rate of metastases and survival of BSRM are similar to unilateral disease, and AS is a safe option in these cases. Few studies focused on RAPN related outcomes for BSRMs, but all confirmed the safety, feasibility, and efficacy of this procedure. Finally, one step RAPN resulted as feasible as the two staged procedures, especially when selective clamping techniques can be chosen.
Keywords
INTRODUCTION
Bilateral kidney cancers account for approximately 3% of renal tumors[1]. Although bilateral renal tumors remain common in patients with genetic renal cell carcinoma (RCC) syndromes [von Hippel-Lindau (VHL) syndrome, tuberous sclerosis, Birt-Hogg-Dubé syndrome] in which a precise DNA related defect can be identified, the majority of bilateral kidney cancer patients showed sporadic, nonfamilial bilateral renal tumors[2,3].
Many factors have contributed to the increase in the prevalence of bilateral renal tumors including the overall growth of kidney cancer incidence rates, early detection due to cross-sectional imaging, increased life expectancy and longer follow-up periods of cancer survivors[4-7].
However, the management and decision-making in these cases are controversial, and both the European Association of Urology (EAU)[8] and the American Urological Association (AUA)[9] Guidelines suggest that patients presenting with bilateral renal masses should undergo genetic counseling and a nephron-sparing approach; however, any standardized disease management is still recommended.
Furthermore, an increasing rate of these patients harboring small renal masses (SRM) at diagnosis has been observed. This reads that along with nephron sparing surgery (NSS) also active surveillance (AS) and ablative therapies (ATs) should be considered.
Regarding AS, sporadic bilateral synchronous renal masses (BSRM) showed no clinically meaningful differences from unilateral SRMs in terms of progression and development of metastatic disease[10-12].
Similarly, ablative techniques provide an alternative to surgery and minimize treatment-related morbidity, particularly for patients with significant comorbidity and pre-existing renal conditions such as chronic kidney disease and/or multiple RCC or genetic RCC related syndrome[13-15]. In this review article, we provide an overview of each possible treatment option for BSRMs.
PREOPERATIVE MANAGEMENT
The National Cancer Institute proposed an algorithm[16] for the workup and management of patients with bilateral, multifocal, and known or suspected hereditary syndromes.
Pre-treatment characterization is crucial as the rationale of staged surgery focuses on obtaining an accurate surgical anatomy assessment, a definitive histology of one side mass and on the concordance probability between BSRMs. Differently, in order to find the gap of indication for simultaneous surgery, a patient selection must be performed through pre-treatment mass characterization by advanced novel imaging methods [i.e., positron emission tomography (PET)/computed tomography (CT), multiparametric magnetic resonance imaging (mpMRI)], and histogenetic analysis (i.e., biomarkers, biopsy) in order to differentiate as precisely as possible benign from malignant BSRMs. This point of focus will probably be unraveled with the advances and implementation of novel imaging methods and genetic analysis.
Novel imaging methods have been shown to improve the pre-treatment characterization of renal masses, such as mpMRI, molecular imaging, radiomics and artificial intelligence to enhance the interpretation of imaging studies.
For example, the use of mpMRI or 99mTc-sestamibi (SestaMIBI, MIBI) single photon emission computed tomography (SPECT)/CT has shown promising initial results to diagnose clear cell RCC (ccRCC) via a clear cell likelihood score (ccLS) in SRMs[17,18] and for the differentiation between benign and low-grade RCC[19]. This has many clinical implications in the decision-making process as reported in the collaborative review by Roussel et al.[20].
Preoperative assessment should also include renal function assessment with renal scintigraphy to better delineate split renal function at baseline which will be helpful for surgical planning, type of access and treatment choice[21,22].
Advancements in imaging technologies, such as mpMRI and 99mTc-sestamibi SPECT/CT, are significantly enhancing the preoperative characterization of renal masses. These technologies aid in distinguishing benign lesions from malignant ones, which can inform the decision-making process regarding whether to pursue AS or surgical intervention. Furthermore, as our understanding of the genetics of RCC progresses - especially concerning hereditary syndromes - genetic testing is becoming an essential aspect of patient management. This shift toward personalized care allows for the development of treatment plans tailored to individual genetic and molecular profiles, which is expected to influence future clinical guidelines. However, despite these advancements, there remains a notable gap in randomized trials that directly compare outcomes between simultaneous and staged surgeries and between surgical and ablative treatments. Long-term studies are still necessary to assess oncological outcomes and the preservation of renal function, which will help refine current treatment protocols.
TREATMENT STRATEGIES
The EAU guidelines[8] emphasize a nephron-sparing approach in the treatment of BSRMs, especially for patients with predisposing genetic conditions, such as VHL syndrome, Birt-Hogg-Dubé syndrome, or tuberous sclerosis complex. For patients without hereditary conditions, the focus remains on maximizing the preservation of renal function while providing oncological control. Similarly, AUA guidelines[9] support a nephron-sparing strategy and genetic testing for patients with BSRMs.
Preoperative treatment planning is necessary to achieve two important targets: complete tumor resection and the maintenance of renal function adequate to keep the patient off hemodialysis.
Surgeons can choose between a simultaneous or a two-step approach.
Most surgeons prefer a two-different-step approach. The main reason is the contralateral kidney compensation to face a period of transitory unilateral renal insufficiency.
On the contrary, others prefer simultaneous bilateral intervention which could reduce mental and physical stress, require single anesthesia, less medication, less blood loss, shorter hospital stay and convalescence, along with considerable cost savings.
Moreover, the increase of SRM detection as the first presentation of kidney cancer has led to a treatment change. Alongside NSS, AS and AT have been emerging as alternatives in SRM treatment. Scientific data prove that SRMs have little potential for metastasis and disease-related mortality due to their benign or low-grade histology[23-25].
NON-SURGICAL TREATMENT
In this context, AS and AT are also considered valid options in the treatment of BSRMs[10,12].
AS
AS is increasingly recognized as a safe option for patients with SRMs, including those with bilateral synchronous renal tumors. Both the EAU and AUA guidelines support AS in patients where surgery is high-risk or unnecessary due to slow tumor growth.
AS should be considered a valid option in both hereditary and sporadic syndromes.
The strategy of combining AS with minimally invasive interventions, especially in hereditary syndromes[26], allows for the preservation of renal function and provides metastasis-free survival based on the assumption that renal tumors less than 3 cm in size show low rate of metastases and progression.
Regarding non-hereditary bilateral synchronous, AS combined with delayed interventions is a valid option as demonstrated by a TUCAN database study[10,12].
They observed 33 patients harboring synchronous SRMs and treated with AS with a mean follow-up of more than six years, comparing their oncological outcomes with their unilateral counterparts.
Specifically, the intervention and growth rate and the development of metastases within BSRM patients were similar, as for metastasis-free, disease-specific or overall survival to those with unilateral SRM. These findings agree with current European and American guidelines[8,9], showing that BSRMs under AS tend to have outcomes similar to unilateral SRMs, with low rates of metastasis and cancer-specific mortality[12,27]. Close monitoring with regular imaging is crucial to detect progression that might necessitate delayed intervention.
Ablative techniques
For patients unsuitable for surgery or those with genetic syndromes that predispose them to multiple bilateral renal tumors, ATs [e.g., radiofrequency ablation (RFA) and cryoablation (CA)] provide a nephron-sparing alternative. Both the EAU and AUA guidelines support these approaches in appropriate cases. RFA and CA are minimally invasive and can be performed percutaneously or laparoscopically. Studies demonstrate high local control rates (e.g., 93.1% for RFA), with minimal impact on renal function. CA, in particular, has been associated with lower rates of renal function decline compared to partial nephrectomy. However, both methods may require repeat treatments for tumor recurrence or incomplete ablation.
Ablative techniques are fit for patients with kidney cancer genetic syndromes because of the increased likelihood of multiple bilateral renal tumors (VHL syndrome, tuberous sclerosis, and Birt-Hogg-Dubé syndrome). However, also in the treatment of sporadic BSRM, these techniques are a valid option, as reported in two studies[28,29]. According to European and American guidelines, RFA and CA are associated with lower perioperative morbidity compared to surgery and are suitable for patients with small, localized tumors[30,31] or those with high surgical risk[32-34].
Specifically, RFA and CA are the main used ablative techniques for the treatment of BSRM[28,29], both of which could be performed percutaneously, open or via a laparoscopic approach.
Both approaches appear to have acceptable rates of perioperative complications and effects on renal function[28,29].
Concerning RFA, Zhang et al. focused on nine patients treated with bilateral RFA through different approaches[29]. During the mean 33 months of follow-up, local tumor control rate was 93.1%, and both the cancer-specific and the overall survival rate were 100%.
Regarding functional outcomes, no statistically meaningful decline in renal function was observed between postoperative and preoperative levels (93.7 ± 13.0 mL/min/1.73 m2vs. 96.9 ± 13.3 mL/min/1.73 m2, respectively; P > 0.05).
Regarding CA, Mason et al. compared percutaneous CA (n = 13), under either CT or ultrasound (US) guidance, with partial nephrectomy (n = 75 underwent open approach and n = 1 underwent laparoscopic approach) in terms of functional and perioperative outcomes[28].
They found that the median change in estimated glomerular filtration rate (eGFR) from preoperative to the time of discharge was -32% [interquartile range (IQR) -46, -15] for partial nephrectomy (PN) patients and
SURGICAL TREATMENT
In contrast to hereditary disease, where tumor growth is fast, and SRM is usually managed with AS and multiple minimally invasive ablative procedures, bilateral sporadic SRM can be managed by a single minimally (both laparoscopic or robot assisted) NSS with acceptable morbidity[35-40].
The robotic surgery for large renal mass (ROSULA) collaborative group highlighted the importance of performing NSS in these patients compared to radical surgical treatment[41].
Patients undergoing PN exhibited significantly better preservation of eGFR[41] compared to those undergoing radical nephrectomy (RN). The study concluded that, despite the complexity of the tumor, PN should be prioritized when feasible due to its renal function preservation benefits, especially in patients at risk for long-term renal insufficiency. For bilateral masses, this is particularly relevant, as bilateral RN would almost certainly lead to dialysis dependency, while PN allows for partial preservation of kidney function in both kidneys.
Focusing on the oncological outcomes and perioperative complications associated with PN[42]vs. RN in treating complex renal masses, both PN and RN provided excellent oncological control, with no significant difference in cancer-specific survival or recurrence rates between the two approaches, even in cases of large or complex tumors. However, the complication rates were slightly higher in PN due to the technical complexity of preserving renal tissue, particularly for hilar or endophytic tumors. Despite this, the overall morbidity associated with PN was acceptable. These findings support current guidelines[8,9].
that prioritize PN over RN in managing bilateral renal masses to reduce the likelihood of dialysis and maintain long-term renal health, without compromising oncological safety.
Minimally invasive surgery is the method of choice for treating bilateral sporadic SRM, as it has a comparable prognosis to that for unilateral sporadic SRM[10-12]. However, surgical management of bilateral synchronous SRM is a surgical challenge, because of two different goals: the minimal postoperative renal function loss and the complete eradication of the renal tumor. For this reason, if technically feasible, the preservation of both kidneys through a bilateral NSS would be preferred.
Specifically, robotic approach, thanks to the wide maneuverability and three-dimensional vision, allows a blunt dissection of the tumor pseudocapsule from the healthy parenchyma and an easier suture of the renal parenchyma[43,44] in unilateral SRM.
Additionally, and especially in the case of BSRM, robotic approach could enable simultaneous bilateral procedures maintaining the same position of the robot beside the surgical bed. This results in shorter operative time and cosmetic benefits as the minimal incisions for the trocar ports can be partially used for both sides[30,40].
A recent review[45] addressed the management of complex renal tumors, such as those that are large (cT2-T3), endophytic, hilar, or occur in a solitary kidney. These conditions often pose significant challenges in traditional surgical settings. The findings support RAPN as a viable option in the case of bilateral renal masses, since it maintains oncological control while preserving renal function.
Managing synchronous bilateral renal masses, especially in complex regions such as the renal hilum, could be challenging. RAPN allows surgeons to access difficult-to-reach tumors with greater dexterity and precision, offering better outcomes in complex surgeries compared to traditional laparoscopic or open surgeries, in terms of lower blood loss, shorter hospital stays, and quicker recovery times[46].
In summary, this systematic review underscores the importance of RAPN as a safe and effective surgical option for managing bilateral renal masses, particularly in complex cases where traditional approaches may pose higher risks or complications.
Nevertheless, a lot of questions are still open, mainly regarding the approach of the renal pedicle (unclamping, selective, or main clamping), the optimal timing for surgery (one vs. two-step surgeries) and the complication rate.
Management of the vascular pedicle
Preoperative planning to avoid clamping of the main renal artery is crucial in minimizing renal damage. In a series by Gallo et al., artery clamping was avoided or minimized in many cases, leading to a low warm ischemia time (WIT) and improved renal function over time[47].
Two recently published reviews showed that the data reported in literature regarding renal pedicle management are still not homogenous[48,49].
For example, two studies demonstrated that selective clamping is preferred over total bilateral renal artery clamping, as it could prevent the onset of postoperative acute kidney injury (AKI) in patients[40,47]. On the contrary, two other studies focusing on main clamping RAPN observed postoperative AKI[37,39].
However, due to the lack of data on medium and long-term follow-up, it is not possible to presume that the risk of AKI may overwhelm the benefits of single-stage surgery[37,39].
The optimal time for surgery
The superiority of either the simultaneous or staged surgical procedure for these patients remains controversial. However, the optimal time for surgery should depend on expertise and surgical complexity. Tailored planning and appropriate patient counseling are important.
Procedure should be staged in patients where there is a high risk of AKI and long hospitalization. Moreover, RENAL nephrometry score should be assessed for each patient[50,51].
On the other hand, simultaneous procedures could decrease the cost in terms of single anesthesia time, shorter overall hospitalization and faster overall recovery than two-step surgeries. Moreover, a single-step strategy might have an impact on oncological outcomes, avoiding delay.
Nevertheless, these advantages could be balanced by the potential risks of AKI increased due to the possibility of bilateral clamping approaches to renal pedicles.
The Mayo Clinic reported that 10.8% of patients undergoing simultaneous bilateral PN experienced AKI, but none required dialysis[28]. Staged procedures are recommended for patients with impaired renal function. Lowrance et al. noted that sequential procedures could better preserve renal function and reduce the likelihood of dialysis[52].
However, the only available study comparing simultaneous vs. two-step RAPN did not report any significant difference in either functional or oncologic outcomes[39].
Complications
Similar intraoperative and postoperative complication rates were reported after RAPN for unilateral or bilateral RAPN[53,54]; furthermore, any conversion to open surgery was described in all the papers included in the two most recent published reviews[48,49].
Pandolfo et al. reported postoperative complication rates during simultaneous bilateral RAPN, including renal hemorrhage, in 25.9% of cases, with major complications being rare (3.7%) and PSM rate of 3.7%, comparable to unilateral procedures[45].
The authors concluded that simultaneous bilateral PN is feasible in expert hands with good functional and oncologic outcomes[45].
Table 1 summarized the complications and the oncological outcomes in patients with synchronous bilateral renal masses treated with surgery, AS, or AT.
Surgical vs. non-surgical treatment: oncological and functional outcomes
| Study | Treatment type | Sample size and FU | Survival rates | Recurrence rates | Complications |
| Sheikh et al., 2018[12] | AS | 70, 72 months | 5-year OS 100% 5-years CSS 95% MFS 100% | 4% | 15% (major complications) |
| Mason et al., 2018[28] | Bilateral PN or PCA, FU not reported | 76 PN and 13 PCA | NR | NR | 20% (mostly minor) |
| Zhang et al., 2018[29] | RFA and open RN | 3 one-stage RN and RFA and 9 one-stage RFA, 33 months | 5-year CSM 100% 5-year OS 100% | NR | 33% (only minor) |
| Hillyer et al., 2011[36] | One-stage RAPN vs. two-stage LPN | 18 RAPN vs. 32 LPN, 7.5 months | NR | NR | 11% RAPN vs. 12.5% LPN (2 patients with major complication in LPN group) |
| Di Maida et al., 2022[40] | One vs. two-stage OPN or RAPN or RN | 41 patients, 42 months | DFS 90.2% CSM 7.3% | Local 2.4% Systemic 7.3% | CD II 7.3% CD III 4.9% |
| Lowrance et al., 2010[52] | One-stage OPN, one-stage ORN, RN followed by PN, PN followed by RN | 73 patients, of those 32 one-stage OPN, 38 months | 5-year OS 85% | 13% | 15% (major complications) |
Simultaneous bilateral PN offers high cancer control rates with no progression to metastasis, though there is a risk of AKI. Long-term renal function is generally preserved, with only a minimal decline in eGFR.
AS is an effective approach for BSRMs, providing outcomes comparable to those seen in unilateral cases, with no significant impact on renal function.
RFA achieves excellent local tumor control while minimizing effects on renal function, with cancer-specific and overall survival rates similar to surgical treatments.
CA yields comparable oncological outcomes to RFA, with a slight advantage in preserving renal function when compared to partial nephrectomy.
A two-step bilateral PN also offers high oncological control but better preserves renal function than simultaneous surgery, particularly for patients at higher risk of AKI.
CONCLUSIONS
Current guidelines from both the EAU and AUA emphasize the importance of a nephron-sparing approach for BSRM, with PN being the preferred treatment when feasible. AS and AT are valuable alternatives, particularly for patients with small tumors or significant comorbidities. The decision between simultaneous and staged surgery should be individualized based on patient-specific factors, with the aim of maximizing oncological control while preserving renal function. Emerging imaging modalities and genetic profiling are expected to further refine treatment strategies for these patients.
DECLARATIONS
Authors’ contributions
Literature research, writing and editing: Pecoraro A
Literature research writing: Diana P
Availability of data and materials
Not applicable.
Financial support and sponsorship
None.
Conflicts of interest
Both authors declared that there are no conflicts of interest.
Ethical approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Copyright
© The Author(s) 2024.
REFERENCES
1. Patel AR, Lee BH, Campbell SC, Zhou M, Fergany AF. Bilateral synchronous sporadic renal tumors: pathologic concordance and clinical implications. Urology 2011;78:1095-9.
2. Tracy CR, Raman JD, Donnally C, Trimmer CK, Cadeddu JA. Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer 2010;116:3135-42.
3. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 2006;98:1331-4.
4. Wang B, Gong H, Zhang X, et al. Bilateral synchronous sporadic renal cell carcinoma: retroperitoneoscopic strategies and intermediate outcomes of 60 patients. PLoS One 2016;11:e0154578.
5. Qi N, Li T, Ning X, Peng X, Cai L, Gong K. Clinicopathologic features and prognosis of sporadic bilateral renal cell carcinoma: a series of 148 cases. Clin Genitourin Cancer 2017;15:618-24.
6. Pahernik S, Cudovic D, Roos F, Melchior SW, Thüroff JW. Bilateral synchronous sporadic renal cell carcinoma: surgical management, oncological and functional outcomes. BJU Int 2007;100:26-9.
7. Jacobs BL, Gibbons EP, Gayed BA, Whetstone JL, Hrebinko RL. Management of bilateral synchronous renal cell carcinoma in a single versus staged procedure. Can J Urol 2009;16:4507-11.
8. Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology guidelines on renal cell carcinoma: the 2022 update. Eur Urol 2022;82:399-410.
9. Campbell S, Uzzo RG, Allaf ME, et al. Renal mass and localized renal cancer: AUA guideline. J Urol 2017;198:520-9.
10. Blute ML, Itano NB, Cheville JC, Weaver AL, Lohse CM, Zincke H. The effect of bilaterality, pathological features and surgical outcome in nonhereditary renal cell carcinoma. J Urol 2003;169:1276-81.
11. Paterson C, Yew-Fung C, Sweeney C, Szewczyk-Bieda M, Lang S, Nabi G. Predictors of growth kinetics and outcomes in small renal masses (SRM ≤ 4 cm in size): Tayside active surveillance cohort (TASC) study. Eur J Surg Oncol 2017;43:1589-97.
12. Sheikh NA, Khan MH, Pillai S, Lang S, Nabi G. Outcomes of synchronous and metachronous bilateral small renal masses (< 4 cm): a population-based cohort study. Int Urol Nephrol 2018;50:657-63.
13. Campi R, Muselaers S, Bertolo R, et al; EAU Young Academic Urologists (YAU) Renal Cancer Working Group. Selecting the best candidates for non-surgical management of localized renal masses: the Occam’s razor. Minerva Urol Nephrol 2022;74:368-71.
14. Bertolo R, Amparore D, Diana P, et al; EAU Young Academic Urologists (YAU) Renal Cancer working group. Cryoablation of small renal masses in patients with solitary kidneys: worth crossing the road for? Minerva Urol Nephrol 2022;74:794-8.
15. Marchioni M, Amparore D, Ingels A, et al; European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group. Renal tumors ablation. Minerva Urol Nephrol 2021;73:549-51.
16. Shuch B, Singer EA, Bratslavsky G. The surgical approach to multifocal renal cancers: hereditary syndromes, ipsilateral multifocality, and bilateral tumors. Urol Clin North Am 2012;39:133-48, v.
17. Johnson BA, Kim S, Steinberg RL, de Leon AD, Pedrosa I, Cadeddu JA. Diagnostic performance of prospectively assigned clear cell likelihood scores (ccLS) in small renal masses at multiparametric magnetic resonance imaging. Urol Oncol 2019;37:941-6.
18. Steinberg RL, Rasmussen RG, Johnson BA, et al. Prospective performance of clear cell likelihood scores (ccLS) in renal masses evaluated with multiparametric magnetic resonance imaging. Eur Radiol 2021;31:314-24.
19. Wilson MP, Katlariwala P, Murad MH, Abele J, McInnes MDF, Low G. Diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytomas and other benign renal lesions: a systematic review and meta-analysis. Abdom Radiol 2020;45:2532-41.
20. Roussel E, Capitanio U, Kutikov A, et al. Novel imaging methods for renal mass characterization: a collaborative review. Eur Urol 2022;81:476-88.
21. Bertolo R, Fiori C, Piramide F, Amparore D, Porpiglia F. The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy. Int Braz J Urol 2018;44:740-9.
22. Porpiglia F, Bertolo R, Amparore D, et al. Evaluation of functional outcomes after laparoscopic partial nephrectomy using renal scintigraphy: clamped vs clampless technique. BJU Int 2015;115:606-12.
23. Pecoraro A, Rosiello G, Luzzago S, et al. Small renal masses with tumor size 0 to 2 cm: a SEER-based study and validation of NCCN guidelines. J Natl Compr Canc Netw 2020;18:1340-7.
24. Rosiello G, Pecoraro A, Luzzago S, et al. Prognostic factors in patients with small renal masses: a comparison between <2 vs. 2.1-4 cm renal cell carcinomas. Cancer Causes Control 2021;32:119-26.
25. Pecoraro A, Palumbo C, Knipper S, et al. 710 - Synchronous metastases rates in T1 renal cell carcinoma: a SEER-based study. Eur Urol Open Sci 2020;19:e1087-9.
26. Haas NB, Nathanson KL. Hereditary kidney cancer syndromes. Adv Chronic Kidney Dis 2014;21:81-90.
27. Uzosike AC, Patel HD, Alam R, et al. Growth kinetics of small renal masses on active surveillance: variability and results from the DISSRM registry. J Urol 2018;199:641-8.
28. Mason RJ, Atwell T, Lohse C, et al. Synchronous nephron-sparing approaches for bilateral renal masses: peri-operative and renal functional outcomes. BJU Int 2018;122:243-8.
29. Zhang S, Zhao X, Ji C, et al. Radiofrequency ablation of synchronous bilateral renal cell carcinoma. Int J Urol 2012;19:241-7.
30. Pickersgill NA, Vetter JM, Kim EH, et al. Ten-year experience with percutaneous cryoablation of renal tumors: tumor size predicts disease progression. J Endourol 2020;34:1211-7.
31. Morkos J, Porosnicu Rodriguez KA, Zhou A, et al. Percutaneous cryoablation for stage 1 renal cell carcinoma: outcomes from a 10-year prospective study and comparison with matched cohorts from the national cancer database. Radiology 2020;296:452-9.
32. Pecoraro A, Palumbo C, Knipper S, et al. Cryoablation predisposes to higher cancer specific mortality relative to partial nephrectomy in patients with nonmetastatic pT1b kidney cancer. J Urol 2019;202:1120-6.
33. Johnson BA, Sorokin I, Cadeddu JA. Ten-year outcomes of renal tumor radio frequency ablation. J Urol 2019;201:251-8.
34. Trudeau V, Larcher A, Dell’Oglio P, Boehm K, Bishr M, Karakiewicz PI. Local tumour ablation for localized kidney cancer: practice patterns in Canada. Can Urol Assoc J 2015;9:420-3.
35. Seo IY, Rim JS. Bilateral robotic single-site partial nephrectomy. J Laparoendosc Adv Surg Tech A 2011;21:435-8.
36. Hillyer SP, Autorino R, Laydner H, et al. Robotic versus laparoscopic partial nephrectomy for bilateral synchronous kidney tumors: single-institution comparative analysis. Urology 2011;78:808-12.
37. Jung JH, Arkoncel FR, Lee JW, et al. Initial clinical experience of simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. Yonsei Med J 2012;53:236-9.
38. Giberti C, Gallo F, Schenone M, Cortese P. Simultaneous bilateral robotic partial nephrectomy: case report and critical evaluation of the technique. World J Clin Cases 2014;2:224-7.
39. Otoshi T, Yamasaki T, Hirayama Y, Uchida J. Pilot experience of simultaneous robotic-assisted partial nephrectomy for bilateral renal tumors-single center analysis. Asian J Endosc Surg 2021;14:57-62.
40. Di Maida F, Grosso AA, Sforza S, et al. Surgical management of synchronous, bilateral renal masses: a 1-decade referral center experience. Eur Urol Focus 2022;8:1309-17.
41. Cerrato C, Meagher MF, Autorino R, et al. Partial versus radical nephrectomy for complex renal mass: multicenter comparative analysis of functional outcomes (Rosula collaborative group). Minerva Urol Nephrol 2023;75:425-33.
42. Cerrato C, Patel D, Autorino R, et al. Partial or radical nephrectomy for complex renal mass: a comparative analysis of oncological outcomes and complications from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group. World J Urol 2023;41:747-55.
43. Mari A, Di Maida F, Tellini R, et al. Oncologic outcomes in patients treated with endoscopic robot assisted simple enucleation (ERASE) for renal cell carcinoma: results from a tertiary referral center. Eur J Surg Oncol 2019;45:1977-82.
44. Minervini A, Campi R, Di Maida F, et al. Tumor-parenchyma interface and long-term oncologic outcomes after robotic tumor enucleation for sporadic renal cell carcinoma. Urol Oncol 2018;36:527.e1-11.
45. Pandolfo SD, Cerrato C, Wu Z, et al. A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors. Asian J Urol 2023;10:390-406.
46. Pandolfo SD, Wu Z, Campi R, et al. Outcomes and techniques of robotic-assisted partial nephrectomy (RAPN) for renal hilar masses: a comprehensive systematic review. Cancers 2024;16:693.
47. Gallo F, Sforza S, Luciani L, et al. Simultaneous robotic partial nephrectomy for bilateral renal masses. World J Urol 2022;40:1005-10.
48. Gallo F, Sforza S, Mari A, Luciani L, Schenone M, Minervini A. Robotic partial nephrectomy for bilateral renal masses. Curr Urol Rep 2023;24:157-63.
49. Giulioni C, Maggi M, Pirola GM, et al. The current evidence on surgical management for synchronous bilateral renal tumors: results from a scoping review. World J Urol 2023;41:2107-18.
50. Blute ML, Amling CL, Bryant SC, Zincke H. Management and extended outcome of patients with synchronous bilateral solid renal neoplasms in the absence of von Hippel-Lindau disease. Mayo Clin Proc 2000;75:1020-6.
51. Klatte T, Ficarra V, Gratzke C, et al. A literature review of renal surgical anatomy and surgical strategies for partial nephrectomy. Eur Urol 2015;68:980-92.
52. Lowrance WT, Yee DS, Maschino AC, et al. Developments in the surgical management of sporadic synchronous bilateral renal tumours. BJU Int 2010;105:1093-7.
53. Zaid HB, Parker WP, Lohse CM, et al. Patient factors associated with 30-day complications after partial nephrectomy: a contemporary update. Urol Oncol 2017;35:153.e1-6.
Cite This Article
Open Access
, Pietro DianaHow to Cite
Pecoraro, A.; Diana, P. Possible treatments for synchronous bilateral small renal masses. Mini-invasive. Surg. 2024, 8, 29. http://dx.doi.org/10.20517/2574-1225.2023.90
Download Citation
Export Citation File:
Type of Import
Tips on Downloading Citation
Citation Manager File Format
Type of Import
Direct Import: When the Direct Import option is selected (the default state), a dialogue box will give you the option to Save or Open the downloaded citation data. Choosing Open will either launch your citation manager or give you a choice of applications with which to use the metadata. The Save option saves the file locally for later use.
Indirect Import: When the Indirect Import option is selected, the metadata is displayed and may be copied and pasted as needed.
About This Article
Special Issue
Copyright
Data & Comments
Data
0
Comments
Comments must be written in English. Spam, offensive content, impersonation, and private information will not be permitted. If any comment is reported and identified as inappropriate content by OAE staff, the comment will be removed without notice. If you have any queries or need any help, please contact us at support@oaepublish.com.