[Comparative analysis of conservative surgery versus radical nephrectomy for renal cancer]

To compare the results of conservative surgery (CS) and radical nephrectomy (RN) for the treatment of renal cancer.

Between 1988 and 1999, more than 900 patients were operated for renal cancer in our department. We compared results of CS (partial nephrectomy and/or lumpectomy) to those of RN on 2 groups of matched patients with a similar sample size (n=62) in terms of morbidity, course of renal function, oncological efficacy and survival.

The mean follow-up was more than 5 years for the two groups. This series comprised a predominance of localized (pT1 and pT2) low-grade (1 and 2) tumours: 80%. In our experience, CS was responsible for greater morbidity than RN, essentially because of indications of necessity compared to elective indications. Although the local recurrence rate was significantly higher after CS, analysis of overall and specific survival did not reveal any significant difference between the two groups.

Conservative surgery appears to be a reasonable alternative to radical nephrectomy for the treatment of renal cancer in some indications and allows nephron sparing. This option appears to be all the more justified in view of the increasingly frequent discovery of small tumours in increasingly young patients. The development of minimally invasive techniques, particularly laparoscopy, is another aspect of this "minimal" trauma approach, but must be shown to ensure an equivalent oncological efficacy.