RENAL PARENCHYMA-SPARING SURGERY IN CARCINOMA

Background: There is controversy regarding the role of renal-sparing s urgery in patients with kidney cancer who have a functioning contralat eral kidney. Methods: The present study aimed to review the recent exp erience of renal-sparing surgery at Royal Prince Alfred Hospital (RPAH ), Sydney. Eighteen consecutive patients undergoing conservative surge ry for kidney tumours at RPAH between February 1987 and January 1995, were reviewed. Eleven patients had imperative indications for conserva tive surgery and the remaining seven patients had elective indications . Ten patients had modified enucleation with a mar in of normal parenc hyma. Six patients underwent partial nephrectomy and two had wedge res ections, Patients were followed up at 1, 6 and 12 months, and thence e very 6-12 months. Follow-up ranged from 9 to 104 months (mean: 46.2 mo nths, median: 48 months). Results: Sixteen of the 18 patients were sti ll alive at the end of the follow-up (October 1995), with no clinical evidence of local or distant metastasis. The two deaths were not relat ed to the fact that these patients had conservative surgery. The avera ge tumour dimensions were 43 mm x 49 mm, with an average volume of 194 mm(3). All resections were complete, with margins ranging between 1.0 and 20.0 mm (mean: 8.7 mm). The survival rate in the present study is comparable to those found by other researchers. Conclusions: Conserva tive surgery is indicated in renal tumours where radical surgery would render the patient anephric. Conservative surgery, however, is contro versial in a patient with a normal contralateral kidney. The present s tudy has shown that renal parenchyma-preserving surgery for localized tumours provides a feasible treatment option.