[Partial elective nephrectomy]

Partial nephrectomy is widely accepted as a therapeutic modality in renal cell carcinoma (RCC) in patients with single kidney, bilateral tumor or deteriorated renal function. Currently, long-term survival studies have consolidated partial nephrectomy as the treatment of choice for RCC in selected patients with normal contralateral kidney.

Between July 1990 and January 2008, a total of 102 partial nephrectomy were performed on 100 patients with pre-operative ultrasonography diagnosis of renal carcinoma in 94 cases and complex renal cysts in 6 cases. The pre-operative ultrasonography size varied from 1.5 to 10 cm with an average of 4.85 cm.

Tumor size was correlated with the pathological stage, finding tumors in stage pT1 with sizes less than and greater than 4 cm in 74% and 64%, respectively, and in stage pT2 of 3.7% and 5.4%. Tumor size measured by pre-operative CT scan was compared with the definitive size of the pathology specimen in 93 cases (56<4 cm and 37>4 cm, according to the CT scan). We found high concordance, however in the larger tumors, there was a tendency of the CT scan to overestimate the size. A post-operative gamma scintigraphy with DMSA was performed in 40 patients. The values in the tumors <4 cm (21 patients) were 12-77% (average 43.3%). In tumors between 4 and 7 cm (17 patients), the values were 13.8-53.3% (average 37.6%) and in 2 cases of tumors >7 cm the post-operative DMSA showed 47.5 and 51%.

Partial nephrectomy is currently accepted as elective treatment in incidental kidney tumors less than 4 cm and it is indicated increasingly more frequently in larger tumors and of central localization. The finding of benign pathology in the anatomic-pathology specimen in up to 20% of the incidental renal tumors and low potential of malignancy of the possible satellite lesions in the remnant kidney also support nephron-sparing surgery in these tumors.