Possible treatments for synchronous bilateral small renal masses

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

Ablation / active surveillance / bilateral kidney cancer / nephrectomy

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