Nephron sparing surgery for central renal tumors: Experience with 33 cases

Purpose: Nephron sparing surgery is standard treatment for small, periphera lly located renal cell carcinoma. In patients with a solitary kidney, bilat eral tumors or impaired renal function nephron sparing surgery provides the only option to nephrectomy and subsequent hemodialysis or transplantation. We retrospectively investigated the value of nephron sparing surgery for c entrally located renal cell carcinoma. Materials and Methods: Between 1969 and 1997, 311 renal tumor enucleations were performed at our institution. The tumor was centrally located in 33 ca ses. The indication for enucleation was elective in 7 cases and imperative in 26, including bilateral tumor in 16 (metachronous in 9 and synchronous i n 7), chronic renal failure in 4 and solitary kidney in 6. Four patients ha d metastasis at enucleation. Results: Convalescence was unremarkable in 28 cases. Hemorrhage occurred in 1 patient, a urinary fistula In 2 and a local abscess secondary to a urina ry fistula in 1, One patient died postoperatively of heart failure. Average serum creatinine was 1.25, 1.63 and 1.33 mg./dl. preoperatively, at hospit al discharge and at a mean followup of 33 months, respectively. Hemodialysi s was necessary transiently during convalescence in 1 patient and permanent ly starting 6 years after enucleation in another. Definitive histology reve aled oncocytoma in 4 cases and renal cell carcinoma in 29. Disease was stag es pT1 to pT3 in 9, 18 and 2 cases, and grades 1 to 3 in 6, 18 and 5, respe ctively. Local recurrence developed in 2 patients. Mean followup was 5.2 ye ars (range 0.3 to 16.7). At a mean followup of 6.2 years (range 0.7 to 16.7 ) 20 patients were free of disease. In addition to the patient who died pos toperatively, 9 died of renal cell carcinoma at a mean of 1.6 years (range 0.3 to 5.3) and 3 died of other causes at 5, 11 and 12 years postoperativel y, respectively. No patient who underwent elective enucleation died. Conclusions: Nephron sparing surgery for centrally located kidney tumors is technically feasible and associated with an acceptable complication rate. Local tumor control is excellent, and the overall prognosis depends on cont ralateral disease and metastasis, Benign tumors may be diagnosed and remove d without loss of the kidney. By avoiding hemodialysis quality of life is i mproved.