[The conservative surgery of renal carcinoma]

In the period 1986-1997, 387 cases of renal carcinoma were operated upon, at the Department of Urology, Parma General Hospital (Italy). Among these, thirty patients (all together 31 operations, 26 men and 5 women, mean age 58 +/- 11.3 years) have had conservative, nephron-sparing surgery; in 8 patients, conservative procedure was mandatory, due to previous contralateral nephrectomy or renal unreliability (4 RCC, 1 TCC, 1 severe injury, 1 pyonephrosis, 1 end stage insufficiency); in 23 patients, with normal contralateral kidney, the tumor was less than 4 cm in diameter and unique. Preoperatively, all cases had been staged by abdominal TC, chest X-ray, bone scan, renal angiography. 23 of 30 cases showed pathological stages I-II (pT1-T2), while 8 patients had stage III (pT3) tumors. After dismissal we recommended: abdominal echography after three months; again US and TC, chest X-ray after further three months. Then US and/or TC every six months, should the former results suggest a relapse, either locally and/or at a distance. Mean follow-up was 40 months. 6/30 patients (19.3%) died of metastatic disease (mean survival time: 27 months). 25 patients are alive and tumor free after a mean follow-up of 43.1 months. Immediate postoperative complications were 2 cases of urinary fistula treated by ureteral stenting.