NEPHRON SPARING SURGERY IN PATIENTS WITH METASTATIC RENAL-CELL CARCINOMA

Purpose: We evaluated the Pole of nephron sparing surgery in patients with metastatic renal cell carcinoma. Materials and Methods: A total o f 15 patients with metastatic renal cell carcinoma underwent nephron s paring surgery and treatment of metastases, including 4 who received a djunctive biological response modifier therapy. The 9 patients in grou p 1, who previously underwent contralateral nephrectomy for renal cell carcinoma and complete resection of all metastases, presented for tre atment of localized renal cell carcinoma in the remaining kidney with no other evidence of disease. The 6 patients in group 2 presented with localized renal cell carcinoma requiring nephron sparing surgery and concomitant distant metastases. Mean postoperative followup was 30.4 m onths. Results: Of 9 patients in group 1, 6 (66.7%) were disease-free at a mean of 31.3 months after nephron sparing surgery and, 102.2 mont hs after detection of metastatic disease, while 3 (33.3%) died at a me an of 53.3 and 73.0 months, respectively. Among the 6 patients in grou p 2, 4 (66.7%) were disease-free at a mean followup of 16.8 months and 2 (33.3%) died at a mean of 20.5 months postoperatively. Of the 4 pat ients who received adjunctive biological response modifier therapy 3 w ere disease-free at a mean of 12.7 months and 1 died 7 months after tr eatment. Satisfactory overall renal function was preserved in 14 of 15 patients after nephron sparing surgery. Conclusions: We conclude that nephron sparing surgery can provide effective treatment for select pa tients with renal cell carcinoma and previously or recently treated me tastatic disease.