[Local recurrence of renal cell carcinoma after radical nephrectomy].

Radical nephrectomy was made in 483 patients with renal cell carcinoma (RCC) without metastases admitted to National Urology Center in 1989-2004. Isolated local recurrence was observed in 10 (2.07%) patients who were divided into two groups. The recurrent tumor was removed in 6 patients of group 1, four patients of group 2 received conservative treatment. Statistic processing was made with Kolmogorov-Smirnov test and unmatched t-test. Survival was estimated according to Kaplan-Meyer, significance of the differences--by log rank test. Three patients of group 1 died of progression of basic disease. Only 1 patient from group 2 was alive 22 months after detection of the recurrence. Mean survival in group 1 was 27.5 +/- 14.9 months, in group 2--10 +/- 8.5 months (p = 0.045). A mean size of the recurrent tumor in survivors was 5.4 +/- 2.1 cm, while in dead patients--10.05 +/- 2.76 cm (p = 0.02). Radicalism of the recurrent tumor removal influenced survival of the patients (p = 0.019). In survivors local recurrence developed 35.7 +/- 28.1 months after radical nephrectomy; in the deceased the recurrence arose 23.3 +/- 25.5 months after nephrectomy (p = 0.46). Thus, early detection of isolated local recurrence of a relatively small size allows complete recovery in some surgically treated patients.

[Long-term results of nephron-sparing surgery for small renal tumors with elective indications].

The widespread use of modern radiological techniques substantially changed clinical presentation of renal cell carcinoma (RCC) in the recent decades. Currently, more than one half of all patients with surgically resectable renal tumors are detected incidentally. In this due interest in nephron sparing surgery (NSS) for the treatment of small localized tumors has increased. The amount of healthy parenchyma that should be removed together with the tumor to minimize the risk of local recurrence is an important and controversial issue. In the present study we retrospectively studied 44 cases of NSS performed for elective indications. A total of 44 patients underwent elective NSS from 1994 to 2001. According to the operative techniques the patients were distributed in two groups. Group I consisted of 17 patients who underwent "enucleoresection" with a small part of normal parenchyma around the excised tumors. The rest 27 patients (Group II) underwent NSS by means of enucleation. Mean follow-up was 88.36+/-24.75 months (range: 49-146 months). The mean tumor size was 37,04+/-4,65 cc (range: 25 to 45). There was no perioperative mortality. Hemorrhage was observed in 1 patient (5,9%) from Group I. Urinary leakage was observed in 3 (6,8%) cases in both groups: two (11,7%) in group I and one (3,7%) in group II. No local recurrence was observed during the follow-up period. One patient (2, 8%) developed distant metastases and died at 81 month postoperatively. 5-year cancer specific survival was 97,6 %. Simple tumor enucleation is a safe and acceptable approach for elective NSS. It provides excellent long-term progression-free and cancer specific survival rates, and is not associated with an increased risk of local recurrence compared with partial nephrectomy.