MANAGEMENT OF SMALL UNILATERAL RENAL-CELL CARCINOMAS - RADICAL VERSUSNEPHRON-SPARING SURGERY

Objectives. There is controversy concerning the management of small un ilateral renal cell carcinomas. The present study was undertaken to ev aluate the relative efficacy of radical nephrectomy versus nephron-spa ring surgery in such patients. Methods. Patients with a single, small (less than 4 cm), localized, unilateral, sporadic renal cell carcinoma (RCC) were identified from an institutional registry: From 1975 to 19 92, 88 patients fulfilling these criteria were treated with either rad ical nephrectomy (n = 42) or nephron-sparing surgery (n = 46). The mea n postoperative follow-up interval is 48 +/- 29 months. Results. The r adical and nephron-sparing surgical groups were well matched for patie nt age, sex, renal function, diabetes, hypertension, tumor size, tumor location, and tumor stage. All patients in both groups had low pathol ogic stage RCC. There was no difference between the two groups in term s of the mean hospital stay, the requirement for blood transfusions, o r the occurrence of surgical complications. There was no difference in the mean preoperative and postoperative serum creatinine levels for p atients in the nephron-sparing surgery group. However, the mean postop erative serum creatinine levels were significantly higher than the mea n preoperative levels for patients in the radical nephrectomy group (P < 0.001). A single patient in each group developed recurrent RCC post operatively. The cancer-specific 5-year survival rate for patients in the radical and nephron-sparing surgical groups is 97% and 100%, respe ctively. Conclusions. Radical nephrectomy and nephron-sparing surgery each provide safe and effective curative treatment for patients with a single, small, unilateral localized RCC. The long-term renal function al advantage of nephron-sparing surgery in this setting is not establi shed.