Surgical management of renal tumors 4 cm. or less in a contemporary cohort

Purpose: We evaluated a patient cohort with renal tumors 4 cm. or less trea ted with partial or radical nephrectomy. We compared patient and tumor char acteristics, and survival in these 2 groups. Materials and Methods: We retrospectively analyzed the records of 670 patie nts with a median age of 63 years treated surgically for renal cell carcino ma between July 31, 1989 and July 31, 1997. Renal tumors 4.0 cm. or less we re noted in 252 patients (38%) who underwent a total of 262 procedures, inc luding 183 radical (70%) and 79 partial (30%) nephrectomies. Ten patients r equired 2 operations each because of bilateral renal cell carcinoma. Median followup was 40 months. We compared clinicopathological parameters in the partial and radical nephrectomy groups using chi-square or Wilcoxon analysi s as appropriate. Survival analysis was determined by the log rank test and Cox regression model. Results: The partial and radical nephrectomy groups were comparable with re spect to gender ratio, tumor presentation, histological classification, pat hological stage and complication rate. Median tumor size was 2.5 and 3.0 cm . in the partial and radical nephrectomy groups, respectively (p = 0.0001). Resection was incomplete in 1 patient (1.3%) in the partial and none in th e radical nephrectomy group. There was no local recurrence after either pro cedure, and no significant difference in disease specific, disease-free and overall survival (p = 0.98, 0.23 and 0.20, respectively). Conclusions: Patients with a small renal tumor have similar perioperative m orbidity, pathological stage and outcome regardless of treatment with parti al or radical nephrectomy. Therefore, partial nephrectomy remains a safe al ternative for tumors of this size.