While oncological and survival outcomes were similar between the groups, patients treated with a staged approached had a significantly higher reduction in eGFR at 3 (p=0.015) and 12 (p<0.001) months postoperatively compared to patients who were treated with a simultaneous approach Table 1). In addition, the simultaneously treated patients had a lower length of stay (p<0.001), fewer cases of urinary leak (p=0.018), and fewer Clavien grade 3 or 4 complications (p=0.044).
In suitable patients, the authors favored a simultaneous approach for bilateral synchronous solid renal masses. There was a consensus among audience members that the simultaneous approach was better for patient outcomes given the appropriate scenario. The moderators did, however, acknowledge that this study was prone to selection bias, as only candidates suitable for a longer procedure would undergo the simultaneous approach. The authors also noted that there had been multiple cases in which a simultaneous approach had been planned, but this plan had been changed intraoperatively due to concern for the length of the procedure or the stability of the patient. Ultimately, patient factors are considered paramount in decision making regarding whether or not to proceed with simultaneous bilateral partial nephrectomy.
Presented by: Matvey Tsivian, MD, Mayo Clinic, Rochester Minnesota
Written by: Frank Jefferson, (Department of Urology, University of California-Irvine) medical writer for UroToday.com at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois