Survival, blood pressure, and renal function following nephron-sparing surgery for renal cell carcinoma: A retrospective long-term study

Purpose: Nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) remai ns controversial for elective indications (low stage RCC in the presence of a normal contralateral kidney). in this single center study survival rate and, as novel aspects, the frequency of postoperative arterial hypertension and renal function parameters were investigated to evaluate safety and eff icacy of NSS, Patients and Methods: From 1973 to 1997, a total of 333 patients underwent NSS. The complete data of 193 patients (mean age 59.0 years) until december , 1993 were evaluated. 136 patients were operated for elective indication ( 95% with tumor stage T1 or T2), 57 patients for mandatory indication (bilat eral tumors, solitary kidney, renal insufficiency). The mean Follow-up was 72.3 months (maximum 23 years). Results: Mean tumorsize was lower under elective (3.8 cm) than under mandat ory (4.7 cm) indication. Tumor-specific survival after 5 years was 98% and 81%, respectively. Comparing preoperative vs. follow-up values, arterial bl ood pressure and serum-creatinine values remained unchanged for both indica tions. The incidence of postoperative proteinuria (19% imperative, 11% elec tive indication) was strongly related to hypertension. Conclusions: NSS for RCC under elective indication achieves patient surviva l comparable to the results of radical nephrectomy. The presented data do n ot indicate significant longterm complications such as arterial hypertensio n, proteinuria or deterioration of renal function as a result of glomerulos clerosis or hyperfiltration. This gives further argument for the concept of NSS in RCC as an alternative to radical nephrectomy in the presence of a h ealthy contralateral kidney.