CARCINOMA DE CÉLULAS RENAIS BILATERAL : UM RELATO DE CASO

Abstract

Synchronous bilateral renal cell carcinoma (RCC) is a rare and challenging entity, whose management requires a strict balance between oncological control and renal function preservation to avoid dialysis dependency. A 62-year-old male presented with macroscopic hematuria. Imaging revealed highly complex synchronous bilateral solid renal masses (R.E.N.A.L. score 8x / PADUA 9 on the left; R.E.N.A.L. score 9x / PADUA 10 on the right, associated with a 9.0 cm cyst). With preserved baseline renal function [estimated Glomerular Filtration Rate (eGFR) of 96.6 mL/min/1.73 m²], a staged surgical approach was chosen. In the first stage, an open partial nephrectomy (PN) with cold ischemia was performed on the left. After 38 days, the right-sided intervention, initially planned as a PN, was intraoperatively converted to a radical nephrectomy (RN) due to the lack of a safe cleavage plane. Histopathology confirmed bilateral clear cell carcinoma (pT1b left; pT3a right). A strict perioperative renoprotection protocol was applied. At 17 months of follow-up, the patient remains asymptomatic, recurrence-free, and dialysis-independent, with stable renal function (eGFR 62.1 mL/min/1.73 m²). A sequential surgical approach and intraoperative tactical flexibility, combined with cold ischemia and strict renoprotection, proved highly effective in treating complex bilateral RCC. This case reinforces the importance of prioritizing nephron salvage in the most favorable unit during the first surgical stage to ensure satisfactory oncological and functional outcomes.

Keywords: Carcinoma, Renal Cell; Nephrectomy; Kidney Neoplasms.