Parenchyma-conserving surgery for renal cell carcinoma

Between 1969 and 1992, 32 patients underwent conservative surgery (partial nephrectomy or enucleation) for renal cell carcinoma (RCC). Elective parenchyma-conserving surgery (n = 10) was done in patients with small, peripheral kidney tumors and a normal contralateral kidney. Cancer in a solitary kidney, bilateral tumors, dysfunctional contralateral kidney or chronic renal failure were imperative indications (n = 22) for conservative surgery. In the elective group the tumors were 15-100 mm (mean 37 mm) in diameter, in the imperative group 5 to 200 mm (mean 41 mm). The follow-up was 0.2-192 months (mean 48.7 months). Nine of 22 (41%) patients in the imperative group have died of RCC. There were no renal cancer related deaths in the elective group. The 5-year cause-specific survival rates for the elective and imperative groups were 100% and 46%, respectively. Two patients in the elective group have died of unrelated causes. Local recurrences developed in three of 22 patients in the imperative group after a mean of 5.4 years; two of them had von Hippel-Lindau disease with bilateral RCC. Conservative surgery seems to be a feasible option in small peripheral kidney tumors.