Bilateral synchronous RCC is a rare condition (2). The etiology remains uncertain, whether it results from contralateral RCC metastasis or multiple de novo primary tumors (3). The optimal surgical strategy for managing such cases remains a topic of ongoing debate among clinicians. The choice between staged bilateral surgery and single-stage surgery remains controversial, and the decision should be made based on the physician’s judgment and the patient’s condition (4). Our patient was a refugee affected by the war in Syria and had to return to his country after treatment. Since long-term follow-up and treatment could not be performed, we obtained informed consent and preferred a single-stage surgery.
The literature points out that single-stage bilateral surgery provides oncological and functional outcomes comparable to unilateral surgery (5). Single-stage bilateral kidney surgery offers advantages such as reduced morbidity and mortality associated with anesthesia (6). Additionally, compared to staged nephrectomy, it leads to faster recovery and a shorter surgical process, allowing patients to return to their normal lives more quickly and improving their quality of life (7).
However, single-stage bilateral nephrectomy also has disadvantages. The complexity of the surgical procedure and the increased risk of postoperative complications must be considered. Factors such as the surgical team’s experience, the patient’s overall health status, and tumor characteristics should be taken into account (5,8). In a study by Mason et al. involving 76 patients who underwent single-stage bilateral partial nephrectomy, the procedure was shown to be safe, with a complication rate of 20% (6). In a study published by vignesh et al. in 2020, consisting of 107 patients, they found similar results between single-stage bilateral partial nephrectomy and staged bilateral partial nephrectomy (9). Kotb et al. reported that kidney function was preserved in a case series of three patients undergoing single-stage bilateral partial nephrectomy, with no Clavien-3 or higher complications observed (7). However, in this series, tumor sizes were <3 cm. On the other hand, Wang et al. found that in four patients who underwent single-stage bilateral surgery for renal tumors, renal failure developed within six years of follow-up, and they recommended staged surgeries instead (8).
Rather than hemorrhage, no early postoperative complications were observed in our case. Nevertheless, renal failure developed during follow-ups. We believe this was not due to simultaneous bilateral surgery. Given the tumor location and size, we had to perform total nephrectomy on the left side and remove more than 50% of the kidney tissue on the right side. Therefore, even if a staged nephrectomy had been performed, renal failure might have developed due to the small amount of remaining renal tissue.
In conclusion, the surgical approach for bilateral synchronous RCC remains controversial, and individualized evaluation is crucial. In our case, considering the tumor characteristics and the patient’s overall condition, single-stage surgery was preferred and successfully performed. A review of similar cases in the literature suggests that single-stage surgery provides oncological and functional outcomes comparable to staged surgery while offering significant advantages by eliminating the need for additional surgical procedures. In our patient, combining radical and partial nephrectomy accelerated postoperative recovery and protected the patient from additional surgical and anesthesia risks. This case demonstrates that single-stage surgery can be a safe and effective option when careful patient selection is made.
DISCUSSION
Bilateral synchronous RCC is a rare condition (2). The etiology remains uncertain, whether it results from contralateral RCC metastasis or multiple de novo primary tumors (3). The optimal surgical strategy for managing such cases remains a topic of ongoing debate among clinicians. The choice between staged bilateral surgery and single-stage surgery remains controversial, and the decision should be made based on the physician’s judgment and the patient’s condition (4). Our patient was a refugee affected by the war in Syria and had to return to his country after treatment. Since long-term follow-up and treatment could not be performed, we obtained informed consent and preferred a single-stage surgery.
The literature points out that single-stage bilateral surgery provides oncological and functional outcomes comparable to unilateral surgery (5). Single-stage bilateral kidney surgery offers advantages such as reduced morbidity and mortality associated with anesthesia (6). Additionally, compared to staged nephrectomy, it leads to faster recovery and a shorter surgical process, allowing patients to return to their normal lives more quickly and improving their quality of life (7).
However, single-stage bilateral nephrectomy also has disadvantages. The complexity of the surgical procedure and the increased risk of postoperative complications must be considered. Factors such as the surgical team’s experience, the patient’s overall health status, and tumor characteristics should be taken into account (5,8). In a study by Mason et al. involving 76 patients who underwent single-stage bilateral partial nephrectomy, the procedure was shown to be safe, with a complication rate of 20% (6). In a study published by vignesh et al. in 2020, consisting of 107 patients, they found similar results between single-stage bilateral partial nephrectomy and staged bilateral partial nephrectomy (9). Kotb et al. reported that kidney function was preserved in a case series of three patients undergoing single-stage bilateral partial nephrectomy, with no Clavien-3 or higher complications observed (7). However, in this series, tumor sizes were <3 cm. On the other hand, Wang et al. found that in four patients who underwent single-stage bilateral surgery for renal tumors, renal failure developed within six years of follow-up, and they recommended staged surgeries instead (8).
Rather than hemorrhage, no early postoperative complications were observed in our case. Nevertheless, renal failure developed during follow-ups. We believe this was not due to simultaneous bilateral surgery. Given the tumor location and size, we had to perform total nephrectomy on the left side and remove more than 50% of the kidney tissue on the right side. Therefore, even if a staged nephrectomy had been performed, renal failure might have developed due to the small amount of remaining renal tissue.
In conclusion, the surgical approach for bilateral synchronous RCC remains controversial, and individualized evaluation is crucial. In our case, considering the tumor characteristics and the patient’s overall condition, single-stage surgery was preferred and successfully performed. A review of similar cases in the literature suggests that single-stage surgery provides oncological and functional outcomes comparable to staged surgery while offering significant advantages by eliminating the need for additional surgical procedures. In our patient, combining radical and partial nephrectomy accelerated postoperative recovery and protected the patient from additional surgical and anesthesia risks. This case demonstrates that single-stage surgery can be a safe and effective option when careful patient selection is made.