CONSERVATIVE SURGERY FOR RENAL-CELL CARCINOMA

Conservative surgery was initially limited to patients with localized RCC present bilaterally or in a solitary kidney, in whom radical nephr ectomy would necessitate immediate renal replacement therapy. Today, t he widespread use of abdominal ultrasound as screening modality in pat ients with nonspecific or unrelated symptoms allows the detection of r enal parenchymal tumors rarely seen before : asymptomatic, small and u nilateral neoplasms, often surrounded by a thick and complete pseudoca psule. Global renal function and contralateral kidney are usually norm al and the patients show good performance status. For these reasons an d because of the generally good results of the first experiences, seve ral authors advocate conservative surgery as an elective indication. R ecently, some studies have reported promising results with this approa ch. On the other hand, some controversial issues persist (multifocalit y of RCC, low risk of local relapse and renal failure after radical su rgery, low incidence of tumor in the contralateral kidney) reducing th e opportunity to perform nephron-sparing surgery when the contralatera l kidney is normal. In the present study, we report our experience of nephron-sparing surgery for RCC and we review the current internationa l opinion concerning this treatment.