Adenocarcinoma of the kidney: Nephron-sparing surgical approach vs. radical nephrectomy

Background and Objectives: Radical nephrectomy has been the traditional sur gical treatment for renal cell carcinoma in patients with a normally functi oning contralateral kidney. The necessity for a less aggressive surgical ap proach has emerged in cases in which there is a need to preserve renal func tion. Methods: We retrospectively evaluated the records of 41 patients with local ized, symptomless small renal masses (<5 cm) treated with nephron-sparing s urgery (group A) and 48 patients matched for age, tumor location, size, and stage who were treated with radical nephrectomy (group B). Results: The 5-year cancer-specific survival rates were 97.5% and 98.4% for the treated patients of groups A an B, respectively. No statistical associ ation was found between cancer-specific survival and surgical approach, tum or stage, tumor location, or recurrence. The size of the primary tumor did not seem to influence the cause-specific survival. Local recurrence was obs erved in 3 patients (7.3%) who underwent partial nephrectomy. In our series , the overall incidence of multifocality was 10.4%. Conclusions: We propose segmental renal resection for unifocal small adenoc arcinoma of the kidney in preference to radical surgery as it is corroborat ed by the presented data. (C) 1999 Wiley-Liss, Inc.