NEPHRON SPARING SURGERY IN INCIDENTAL VERSUS SUSPECTED RENAL-CELL CARCINOMA

From 1956 to 1992 nephron sparing surgery was performed in 216 patient s with sporadic renal cell carcinoma. Renal cell carcinoma was suspect ed in 121 patients and was an incidental finding in 95. Compared to su spected renal cell carcinoma, incidental tumors were smaller (p = 0.00 04), more often unilateral (p = 0.001) and of lower pathological stage (p = 0.001). Incidental tumors were also associated with improved 5-y ear cancer-specific survival (p = 0.003) and a lower rate of postopera tive tumor recurrence (p = 0.001). The overall 5-year cancer-specific survival rate was improved in patients with stage I versus higher stag e renal cell carcinoma (p = 0.0002), unilateral versus bilateral disea se (p = 0.0001), a single versus multiple tumors in the operated kidne y(p = 0.01) and tumors smaller than 4 cm. versus larger tumors (p = 0. 03). There were no postoperative tumor recurrences and the 5-year canc er-specific survival rate was 100% in patients with unilateral, stage I tumors smaller than 4 cm. These data define specific eligibility cri teria for nephron sparing surgery in patients with localized unilatera l renal cell carcinoma and a normal contralateral kidney.