[Multifocal renal carcinoma: anatomic-clinical aspects]. / Carcinoma renale plurifocale: aspetti anatomo-clinici.

Between 1992 and 1996 we examined 387 kidneys after nephrectomy for renal cell carcinoma. The capsules were removed and the kidneys were serially sectioned at 5 mm intervals; cortical and intraparenchymal nodules were examined histologically. Of the 387 kidneys 12 (3%) contained multifocal renal cell carcinoma and only 3 with clinically overt tumor ut to 3 cm. in diameter. We conclude that partial nephrectomy should be widely accepted in patients with small renal cell carcinoma in presence of a normal controlateral kidney.

[Conservative therapy of renal parenchymal neoplasia]. / Terapia conservativa della neoplasia renale parenchimale.

We review our overall experience in 1375 patients, who underwent surgery for renal cell carcinoma in the Departments of Urology of Brescia and Bergamo from 1983 to 1996. 185 (13.4%) patients had nephron-sparing surgery: imperative procedure was performed in 74 cases, while an elective surgery was done in 111 patients. Three years minimal follow up was considered in order to evaluate the outcome of surgical treatment in 48 patients who underwent imperative nephron-sparing surgery and in 73 with an elective procedure. Disease specific survival was 80.8% in the first group and it was 97% in the latter.

[Conservative surgery of parenchymal renal carcinoma: urologic data from Lombardy]. / Chirurgia conservativa del carcinoma renale parenchimale: i dati dell'urologia Lombarda.

We report the results of a questionnaire sent to various Urology departments in Lombardy about "Conservative Surgery in Renal Cell Carcinoma" which was the subject of discussion at the 50th meeting of the Lombardian Society of Urologist. 23 centres out of 34 i.e. 68% answered. 100% of the departments performed nephron sparing surgery, 91% in cases of imperative and elective indication and 9% only in imperative indication. 100% of the patients underwent preoperative staging with ultrasound and computer tomography. 48% treated in elective surgery only incidentally asintomatic discovered tumours, but 52% treated both incidentally and sintomatic ones. Elective surgery is suggested when the tumor has a diameter less than or up to 3 cm., from 3 to 5 cm., and more than 5 cm. in 48%, 48% and 4% of the urological departments respectively. 70% consider the importance of tumor location and do not perform partial nephrectomy when the tumor is intraparenchymal or in contact with the secretory tract. From a technical point of view 82% carried out partial nephrectomies while 18% carried out enucleation; 57% performed routinally frozen section on tumor bed and 61% do not performed lymphadenectomy. 83% believe in the multifocality problem. A macroscopic and microscopic haematuria does not condition the elective indication in 62% of the urology departments. The follow-up is carried out with ultrasonography alternated with CT in 78% of the departments and is continued for over 5 years in a likewise 52%. From 1990 to 1995, 3332 patients were surgically treated for renal cell carcinoma in 23 urology departments; 487 (14.6%) underwent nephron sparing surgery; 320 elective and 167 imperative indication. The local global relapse was 2.9% (14/487); 5.3% (9/167) in imperative group and 1.4% (5/320) in elective group. Conservative surgery in Lombardy will always try to have the golden standard treatment in the incidental, single renal cell carcinoma.

[Conservative therapy of parenchymal renal carcinoma]. / Terapia conservativa del carcinoma renale parenchimale.

From January 1987 to October 1990, 20 patients (16 M. 4 F.) affect by localized renal cell carcinoma, underwent a conservative surgical treatment. This case study includes 8 patients with bilateral (4 synchronous-4 asynchronous), and 12 patients with unilateral renal carcinoma. In the latter group only two patients had a pathological contralateral kidney. A parenchyma sparing operation was performed electively in 10 cases and was necessary in the other 10. The tumors were found to be PT1 or pT2 in all the elective cases, except one unexpected pT3a; 1pT1, 5pT2, 1pT3a and 3pT3b in the remaining group. The follow up ranges between 1 and 36 months, two deaths in bilateral tumors cases were observed. No local recurrences have been detected up to now.