LOCAL RECURRENCE AFTER NEPHRON-SPARING TU MOR RESECTION

Although excellent survival rates for nephron-sparing surgery in manda tory indications (solitary kidney bilateral renal neoplasms) have been documented, parenchymasparing surgery in elective indications (normal contralateral kidney) is a point of controversy. Local tumor recurren ce is the most important argument against this approach. From January 1971 to December 1989, 107 patients suffering from renal cell carcinom a in solitary kidneys or bilateral renal carcinoma underwent nephron-s paring surgery. Thirteen patients (12%) suffered from local recurrence between 4 and 112 months after tumor resection. A high proportion of these recurrences were seen within the first 2 years after resection, followed by a almost linear increase thereafter. Thus-there are possib ly two different entities for local recurrence. A correlation between tumor grade and interval from resection to local recurrence could be f ound, with a long average interval for grade 1 tumors - longer than th e published follow-up times for patients undergoing elective tumor res ections. Although most of the patients described in this report do not fulfil the surgical criteria for elective resection, we cannot recomm end parenchyma-sparing surgery in elective indications.