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J.P. Charmes, Service de Néphrologie, Hôpital Universitaire Dupuyten, F-87042 Limoges (France) Dear Sir, We read with great interest the paper by Black et al. [1]. These authors studied the survival of 6 patients with bilateral renal cell carcinoma who underwent radical nephrectomy and renal replacement therapy and found a survival rate of 44% over a 5-year period. We performed the same study. We sent a questionnaire to 204 French dialysis centers in order to determine the survival of these patients. Responses were obtained from 103 dialysis centers, allowing us to review 31 cases of bilateral nephrectomy for renal carcinoma, 9 synchronous and 22 asynchronous bilateral renal carcinomas with a mean interval of 68 months between the two tumors. There were 21 males and 10 females with an average age of 53 years. All had bilateral nephrectomy and required hemodialysis or continuous ambulatory peritoneal dialysis. In 13 cases metastases were detected before nephrectomy. Metastases appeared at an average of 11.5 months following bilateral nephrectomy in 8 patients. Twenty-two patients died. Thirteen patients died of cancer progression, 5 of other causes unrelated to the cancer, and 2 of an unknown cause. Two patients were transplanted after 15 and 16 months on dialysis, respectively, they died 11 months later. The overall actuarial survival after bilateral nephrectomy shows survival rates of 70% for 1 year, 48.5% for 2, 23% for 3, and 16.1% for 4 and 5 years (fig. 1). Survival was longer in patients with synchronous as compared to asynchronous bilateral renal carcinoma. For the majority of these patients the 1 We gratefully acknowledge the cooperation of the dialysis centers which have returned the questionnaire.

Prognosis on Dialysis of 31 Patients after Bilateral Nephrectomy for Bilateral Renal Cancer