THE ROLE OF NEPHRON-SPARING SURGERY IN RENAL-CELL CARCINOMA

Nephron-sparing surgery in renal cell carcinoma is an accepted approac h in patients with bilateral carcinomas, solitary kidneys and in patie nts with chronic renal failure in whom radical nephrectomy would neces sitate immediate renal replacement therapy (mandatory indications). Be cause of the improvement of operative techniques - like renal perfusio n in hypothermia or work-bench surgery - over 95 % of patients can spa red dialysis even if multiple tumors or locally advanced renal cancer is present. Based on the excellent outcome of nephron-sparing surgery in mandatory indications (5-year survival 80 %), several centers advoc ate extending the use of partial nephrectomy to selected patients with a normal opposite kidney (elective indications). Several reports on n ephron-sparing surgery in elective indications with a median follow-up time of 40 months document similar survival rates compared to radical nephrectomy. Nevertheless, due to the low incidence of bilateral rena l carcinomas (under 2 %), only 2 of 100 patients would benefit from th is approach. Furthermore, local recurrence after nephron-sparing surge ry occurs mostly after 4 years (late recurrence); therefore, it seems doubtful whether the short follow-up times really reveal the the true recurrence rate. The prognosis after development of a local recurrence is poor.