Long-term evaluation of functional and oncological outcome of nephron- sparing surgery for treatment of renal tumours: a single center experience

ABSTRACT

We present oar experience with open nephron-sparing surgery [NSS] for treatment of renal masses. We retrospectively reviewed the clinical and pathological data of 106 patients [108 renal units] who underwent NSS /or renal masses between 1983 and 2007 at our institution. Patients' characteristics, the indication of surgery, the preoperative workup, the pathological reports, the postoperative complications, renal function and the oncological outcome were studied. All the patients were followed-up for amean of 60.6 +/- 32.8 [range, 9.4-144.8] months. Renal cell carcinoma [RCC] was diagnosed in 83 patients [85 renal units], while benign lesions were found in 23. Patients were classified according to the indication of NSS into elective group [n =60] and imperative group [n = 46]. Both groups were comparable regarding sex, clinical presentation, tumour site, and tumour laterality. Patients in the elective group were significantly younger and had significantly smaller tumours. Patients with RCC of both indications were comparable regarding Fuhrman grade while those with elective indication had significantly higher number of T1a tumours and those with imperative indication had significantly higher number of conventional tumours. Although perioperative complications were significantly more frequent among the group of imperative indication, they did not result in significant increase in hospital stay. The 5-year progression free and cancer specific survival were 89.6 +/- 4.9% and 93.8 +/- 4.3%, respectively in the imperative group, while no tumour recurred in the elective group. Of patients in the imperative group, one quarter had major changes in serum creatinine compared to basal value and only 3 patients progressed to end-stage renal disease, while in the elective group all patients had either stable or minor changes in serum creatinine postoperatively. NSS is a valid alternative in the treatment of small renal tumours. In. patients with solitary kidneys, it can safely preserve rend function and effectively treat malignancy