Imperative and Elective Indications for Nephron-Sparing Surgery for Renal Tumors: Long-Term Oncological Follow-Up

Abstract

Introduction: Nephron-sparing surgery (NSS) is mandatory for patients with renal tumors in both kidneys or in a solitary kidney in order to preserve renal function (imperative indication). NSS has also become the gold standard (elective indication) for small unilateral renal tumors (< 4 cm) with a normal contralateral kidney. We report the oncological long-term follow-up of NSS of our own series and discuss the results of the current literature. Patients and Methods: From 1979 until 2006, a total of 851 patients was treated at our institu­tion by NSS. The mean tumor diameter was 3 cm (0.5–11 cm) for elective cases and 4.2 cm (1.2–11 cm) for imperative cases. The median follow-up for elective cases is 4.7 years (0.1–24.1 years) and imperative cases 8 years (0.1–25.8 years). Cancer-specific survival (CSS) and local recurrence-free survival (RFS) were estimated. Results: Estimated CSS at 5 and 10 years for elective indications were 98.5 % and 96.7 % and for ­imperative indications (solitary kidney) 89.6 % and 76 %. RFS after 5 and 10 years for elective indications were 98.3 % and 95.7 %; and for imperative indications (solitary kidney) 89.4 % and 79.9 %. Chronic renal failure requiring haemodialysis ­developed after NSS in a solitary kidney in nine patients (11.2 %). Conclusion: NSS can be performed with oncologically safe and good functional results in imperative indications. In elective indications the resectability of a tumour rather than size and location is the limiting factor.

Key words

renal cell carcinoma - nephron-sparing surgery - oncological outcome - elective indication - imperative indication - surgery - complications

References

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