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[Conservative surgery for renal carcinoma]
M González Martín1, L M Alvarez Castelo, V Chantada Abal
1Servicio de Urología, Hospital Juan Canalejo, La Coruña.
Objectives:
To report on our experience in conservative surgery for renal cell carcinoma, pointing at indications, surgical techniques and results. We also make a review of the literature.
Material And Methods:
From 1975 until 1997, 231 patients underwent surgical treatment of renal cell carcinoma. In 17 cases conservative surgery was done. 11 patients were male and 6 female, with age range 33-78 years. Polar nephrectomy was done in 4 cases and tumorectomy in 13 cases. The indication was elective in 10 cases, and imperative in 7 due to: 4 bilateral carcinomas, 1 chronic renal failure, 1 von Hippel Lindau disease and 1 tumor associated with surgical lithiasis of the kidney.
Results:
58.8% of the patients did not have clinical symptoms and the diagnose was incidental. The average size of the tumors was 3.8 cm. The pathological stage was: 3 cases T1N0M0 and 12 T2N0M0. All the T1 cases had an incidental diagnose. The complications were: 1 urinary fistula, 1 haematoma, and 1 case of postoperative fever. All these complications were solved in a conservative way. We had tumoral recurrence in one patient affected with von Hippel Lindau disease. It appeared 4 years after the surgical procedure and required radical nephrectomy. One patient died 24 months after surgery because of causes not related with renal tumor. The rest of the patients are alive, with no tumoral recurrence, within an average follow-up of 49.6 months. None of the patients needed dialysis.
Conclusions:
Our experience, though not great is enough to demonstrate the benefits of conservative surgery for renal cell carcinoma. Partial nephrectomy in selected patients and with the appropriate surgical technique offers short-term results similar to those obtained with radical nephrectomy. It is indispensable to make the resection and intraoperative pathological study of a margin of renal parenchyma surrounding the tumor, and also to examine the whole surface of the kidney to search for satellite tumoral nodules. It is very important to do a close follow up of these patients after the surgery.