MULTICENTRICITY IN RENAL-CELL CARCINOMA

In the era of ultrasound and computerized tomography, when more than 5 0% of renal cell carcinomas are detected incidently, with a high propo rtion of small tumors, the standard treatment of radical nephrectomy i n the presence of a normal contralateral kidney should be questioned. The main objection against conservative surgery for renal cell carcino ma has been the concern about satellite small renal cell carcinomas, w hich have been reported in 7% and 19.7% of 100 and 66 kidneys, respect ively. We studied the incidence of multicentric neoplasms in 50 kidney s: 27 with renal cell carcinoma and 23 autopsied normal kidneys. The i ncidence of small renal cell carcinoma in the kidneys with a tumor was 11.1% and that of small nodules in normal autopsied kidneys was 13% ( none of them was malignant). The incidence of satellite malignant nodu les in patients with renal cell carcinoma 3 cm. or smaller was 3.7% in our series, and 0% and 3% in other series. Therefore, patients who un dergo nephrectomy for tumors up to 3 cm. in diameter may be considered as overtreated in 96 to 100% of the cases. We conclude cautiously tha t partial nephrectomy should be widely accepted in patients with small renal carcinoma and in the presence of a normal contralateral kidney.