Elective nephron sparing surgery in clinical T1b renal cell carcinoma

Abstract

Objective To investigate the safety and feasibility of elective nephron sparing surgery (NSS) in clinical T1b (4-7 cm) renal cell carcinoma (RCC).Methods From January 2005 to Decem-ber 2008,elective NSS was carried out in 30 (19 males,11 females,mean age 56 years,from 39 years to 74 years) asymptomatic,single sited,peripheral,and organ confined RCCs,and the mean tumor size was 5.4 cm (4.2-7.0 cm).Intraoperative frozen section analysis was routinely used in suspect areas.A single urologist carried out the major surgical procedure.Peritumoral margin was 0.5 cm for the cortex and 0.2 cm for the deep part.Maximal diameter of the tumor divided by the maximal diameter of affected kidney (9.6-12.6 cm,mean 11.4 cm) in thin-layer CT scan or MRI was calculated as the relative tumor size (0.38-0.47,mean 0.43).Surgical parameters,pathological characters and clinical outcomes were documented and analyzed.Results Only 1 case was converted to radical nephrectomy due to uncontrollable bleeding during operation.For the rest 29 successful NSSs,median warm ischemia was 17 min (14-30 min) ; median blood lose was 40 ml (20-100 ml),no transfusion needed.All the 30 patients,including 26 clear cells,2 papillary and 2 chromophobe carcinomas,were pathologically confirmed to be T1b.The serum creatinine levels 3 months after operation were similar with those before operation.After a median follow-up of 56 months (36-72 months),all the 30 patients survived without recurrence.Conclusions Elective NSS in clinical T1b renal cell could be effective and safe.Location and relative tumor size should also be taken into account in addition to other ordinary indications. Key words: Kidney neoplasms; Carcinoma; Nephron sparing surgery