Between 1969 and 1992, 32 patients underwent conservative surgery (par
tial nephrectomy or enucleation) for renal cell carcinoma (RCC). Elect
ive parenchyma-conserving surgery (n = 10) was done in patients with s
mall, peripheral kidney tumors and a normal contralateral kidney. Canc
er in a solitary kidney, bilateral tumors, dysfunctional contralateral
kidney or chronic renal failure were imperative indications (n = 22)
for conservative surgery. In the elective group the tumors were 15-100
mm (mean 37 mm) in diameter, in the imperative group 5 to 200 mm (mea
n 41 mm). The follow-up was 0.2-192 months (mean 48.7 months). Nine of
22 (41 %) patients In the imperative group have died of RCC. There we
re no renal cancer related deaths in the elective group. The 5-year ca
use-specific survival rates for the elective and imperative groups wer
e 100 % and 46 %, respectively. Two patients in the elective group hav
e died of unrelated causes. Local recurrences developed in three of 22
patients in the imperative group after a mean of 5.4 years; two of th
em had von Hippel-Lindau disease with bilateral RCC. Conservative surg
ery seems to be a feasible option in small peripheral kidney tumors.