Elective nephron sparing surgery in 69 patients with renal cell carcinoma > 4 cm

Abstract

Purpose: After establishment of nephron-sparing surgery as accepted technique — both in imperative and in elective indications, in tumors < 4 cm and healthy contralateral kidney — the question, according long-term results in elective nephron-sparing surgery in tumors larger than 4 cm, came up. In this unicentric, retrospective longitudinal analysis, results, survival and outcome of this selected group of patients is described.

Material and methods: Between 1975 and 2003, 94 patients with kidney-tumors > 4 cm in diameter and healthy contralateral kidney, were treated by open nephron-sparing surgery. 69 of them had in histological findings renal cell carcinomas (73.4 %). Feedback in 86.2 % of patients was obtained in a current follow-up. Mean observation-time after surgery was at 6.2 years.

Results: 84.1 % of tumors were found accidentally. Tumors were mostly (88.3 %) resected by warm ischemia. Mean time of ischemia was at 17.2 minutes at a mean operation-time of 122.3 minutes. Complications occurred in 12.8 %, whereas only in 2 cases a secondary operation was necessary, in which always remaining kidneys could be saved. Mean diameter of renal cell carcinomas was at 5.33 cm (range: 4.1 to 10.0 cm). Tumor-stage was mostly (89.9 %) at pT1b (TNM-classification from 2002). 2 patients showed perioperatively metastasis, which were resected successfully by secondary surgery. In the observation-time of 6.2 years, 7 patients died but not in case of tumor. So the long-term survival was at 94.9 % (5-year-survival) respectively 86.7 % (10- and 15-year-survival). Tumorspecific survival was after 5, 10 and 15 years always at 100 %.

Conclusion: After establishment of nephron-sparing surgery as standard procedure for renal tumors smaller than 4 cm by healthy contralateral kidney, in most urological centres, a size of 4 cm should not considered as fixed limit for these indications. After detailed selection of patients, surely excellent results in elective nephron-sparing surgery in tumors larger than 4 cm can be achieved.