KIDNEY PRESERVING SURGERY IN RENAL-CELL TUMORS - INDICATIONS, TECHNIQUES AND RESULTS IN 152 PATIENTS

Between 1975 and 1991, 142 patients with renal cell carcinoma and 10 w ith oncocytoma underwent a total of 164 kidney preserving operations. The indication for surgery was imperative (group 1, 47 patients) among those with a solitary kidney (9), renal insufficiency (17) or bilater al tumors (21). Of the patients with small or peripheral tumors and a healthy contralateral kidney 105 were selected for elective surgery (g roup 2). Most procedures were done either without ischemia (24%) or wi th warm ischemia (69%). In some patients from the imperative indicatio n group hypothermia was achieved by in situ perfusion (5%) or ex vivo work bench surgery and autotransplantation (2%). Complication rates we re 15% for group 1 and 9.5% for group 2. In group 1, 3 patients died o f cancer, 5 lived with metastases and 2 had local tumor recurrence. No patient in group 2 had recurrences or metastases. The tumor-specific survival rate of patients with kidney preservation for renal cell carc inoma was comparable to that of a control group undergoing radical nep hrectomy. Due to the high reliability and efficacy, kidney preserving surgery for renal cell carcinoma should be done more often, even in pa tients with a normally functioning contralateral kidney.