Radical nephrectomy in chronic hemodialysis patients with renal cell carcinoma: outcomes and complications

Abstract

Renal cell carcinoma (RCC) is an important complication in patients on long-term chronic hemodialysis in Japan. To assess surgical treatment for RCC in chronic hemodialysis patients, we evaluated the clinical outcomes and complications of radical nephrectomy in these patients. We enrolled 43 patients who underwent radical nephrectomy for RCC t Tokyo Women's Medical College Hospital; 37 men and 6 women, aged from 20 to 80 years (mean: 51.0 years), with a mean hemodialysis period of 121.1 months (1 to 268 months). Fourteen patients were in clinical stage I, 20 in stage II, 5 in stage III and 4 in stage IV. Forty-one patients underwent curative operations. As of the time of prognoses examination in March 1996, the follow-up periods were 2 to 162 months (mean: 36.0 months).
Results. Thirty-four patients survived; 30 were tumor-free and 4 had cancer. Nine patients had died; 7 died of causes unrelated to RCC and only 2 deaths were cancer-specific. The overall 5-year survival rate was 66.1%, and the cancer-specific 5-year survival rate was 87.9%. RCC developed in the contralateral kidney during the observation period in 8 patients, and 5 of them underwent bilateral nephrectomy. Patients on long-term hemodialysis, who acquired multiple renal cysts and multiple tumors and manifested hematuria showed a significantly high incidence of bilateral RCC, and they were all men. Complications of nephrectomy were observed in 17 of the 47 operations, but all were minor problems and improved.
Our results demonstrate that the prognosis for chronic hemodialysis patients with RCC is as good as that for non-hemodialysis patients, and careful obsevation is necessary for patients with multiple acquired cysts and tumors on long-term dialysis.