Comparaison de la chirurgie conservatrice et de la nephrectomie totale elargie dans le traitement du cancer du rein : experience Lyonnaise

ABSTRACT

Objective: Due to the good results obtained during the past 20 years with conservative surgery for the treatment of renal cell carcinoma and the increasing number of cases of small sized renal tumors many authors advocate nephron-sparing surgery as procedure of choice in selected cases. Others underline the risk of multifocality and thus the risk of recurrence and still consider radical nephrectomy the gold standard. We present the results of a retrospective study including two groups of 62 patients each operated on for renal cell carcinoma at our department Group 1 underwent conservative surgery (CS) and Group 2 had a radical nephrectomy (RN). Patients and Methods: Between 1988 and 1999; more than 900 patients with renal cell carcinoma were operated at our institution. Considering two groups of 62 matching patients each; we compared the results of conservative surgery (partial nephrectomy and/or tumorectomy) to those of radical nephrectomy in terms of morbidity; renal function; disease control and survival. The patients were matched according to sex; date of intervention; nuclear grade; pathological stage (UICC classification 1997). Results: The median follow-up was 5 years in both groups. The mean age was 61 years; the sex ratio = 1 2; 2. For both groups; pathological stage and nuclear grade were distributed as follows pT1 and pT2 78; pT3 a 16; pT3b 4; pT3c 2. Fuhrman grade 1 and 2 77; 3 and 4 23. Morbidity Mean hospitalization was 15;5 days for Group 1 (CS) and 11 days for Group 2 (RN) (p= 0;03). The transfusion rate was 30for Group 1 and 5for Group 2 (p 0;001). There was no difference between the two groups in terms of variation of serum creatinine level before and after surgery. The complication rate was 32and 8for Groups 1 and 2; respectively (p