RESUMO
On the basis of two personal cases, the authors undertook an overall study of 108 cases published between 1909 and 1978. First personal case: 2 successive tumours at an interval of 5 years. Total nephrectomy of the 2nd carcinoma resulted in survival for 6 years with hemodialysis. The patient is living, with metastases. Second case: 2 simultaneous carcinomas with adrenal metastases with death following unilateral partial nephrectomy. An exhaustive review of the literature revealed the following interesting statistical factors: 1.8 p. 100 of carcinomas of the kidney are bilateral. Amongst the 108 cases studied, 51 were simultaneous and 57 successive. Treatment becomes appropriately more and more audacious: total nephrectomy on one side and partial on another, double partial nephrectomy, performance "ex vivo" of partial excisions, bilateral total nephrectomy followed by hemodialysis or transplantation. These tumours affect young individuals: mean age 51 years and male in 7 cases out of 10. Mean survival of all cases combined was 18 months, but subtracting operative mortality this increased to 22 months. Mean survival was greater in successive carcinomas, in individuals aged over 55 years (26 months) than in simultaneous carcinomas of the younger age group (13 months). Overall prognosis has improved for simultaneous carcinomas (mean survival 2.5 months for the period 1909--1954 increasing to 25 months for the period 1972--1978); whilst it has remained stable (mean survival 21 months) for successive carcinomas. The mean interval between 2 successive carcinomas was 6 years and 6 months with a range of 5 months for 20 years. Prognosis was based on numerous factors, but in particular treatment. When surgery was incomplete or absent, mean survival was 5 1/2 months (40 cases), the figure reaching 26 months for the 52 cases in whom an adequate excision was performed (of the order of 30 months for the period 1972--1978). No published case should be reported before a minimum survival of 2 years.
