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 30% for Group 1 and 5% for 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 32% and 8% for Groups 1 and 2, respectively [p = 0,001]. Cancer-related results: 11 % positive margins were found in Group 1 and none in Group 2 [p = 0,013]. Local recurrence was noted in 11 % of cases in Group 1 and none in Group 2 [p = 0,013]. Metastatic recurrence was the same in both groups [9,7%]. Survival: The 10-year overall survival was 60% and 70% for Groups 1 and 2, respectively [p = 0, 3]. The 10-year disease free survival was 82% [Group 1] and 84% [Group 2] [p = 0, 11]. Within the CS group, the 10-year disease-free survival was 100% for elective indications and 70% for imperative indications [p = 0,003]
Conclusions: In our series conservative surgery had a higher morbidity than radical nephrectomy. However, no statistical difference was noted between the two groups in terms of overall and disease free survival. As far as renal tumours are now widely discovered at an infraclinical stage in patients with a longer life expectancy, we think that conservative surgery must be considered in first intention in selected cases