Imperative indications for conservative surgery for renal cell carcinoma: 20 years' experience

Introduction: Radical nephrectomy is the treatment of first choice for unil ateral renal cell carcinoma (RCC) with a healthy contralateral kidney; howe ver, the current standard for dealing with RCC in patients with a solitary kidney, bilateral tumor and renal or systemic disease inducing a progressiv e impairment of renal function is nephron-sparing surgery. Materials and Me thods: Between January 1974 and July 1996, 62 patients (39 men and 23 women , 33-77 years old, mean age 60.6 years) with RCC underwent nephron-sparing surgery. The patients were divided in to two groups according to treatment indication: 46 patients with bilateral tumor (n = 21) or solitary kidney (n = 25) and 16 patients with renal or systemic disease that could damage the contralateral kidney. Survival curves were calculated according to the Kap lan-Meyer method. Results: In the first group 3 patients died postoperative ly, and 3 were lost to follow-up; 12 patients (27.9%) had malignant recurre nce and 5 (11.6%) died of local recurrence or systemic diffusion. The proba bility of local or systemic tumor recurrence was 9.9% at 2 years, 20.2% at 5 years and 24.7% at 10 years; the probability of survival was 100% at 2 ye ars, 91.9% at 5 years and 81.9% at 10 years. In the second group 3 patients died of unrelated causes and 1 was lost to follow-up; 4 patients (25%) had a malignant recurrence and 2 (12.5%) died of systemic diffusion of RCC. Th e probability of tumor recurrence was 13.0% at 2 years, 19.7% at 5 years an d 26.4% at 10 years, the probability of survival was 100% at 2 years, 93.3% at 5 years and 86.1% at 10 years. Conclusions: In our experience nephron-s paring surgery seems justified in patients with a solitary kidney, bilatera l tumor or a disease that potentially damages renal function. Tumor diamete r and stage, incidental or symptomatic tumor presentation and specific indi cation for conservative surgery determine the prognosis. Copyright (C) 2001 S. Karger AG, Basel.