Abstract
ObjectivesElective nephron-sparing surgery (NSS) for renal cell carcinoma (RCC)<4cm has been accepted as alternative to radical nephrectomy (RN). However, NSS for tumours >4cm is controversial. We present our experiences and long-term oncologic outcome of RCC>4cm treated with NSS in a retrospective single-institutional analysis of 69 patients. MethodsBetween 1975 and 2004, elective NSS was performed in 368 patients at our institution, including 69 patients with sporadic, nonmetastatic RCC>4cm. Overall and cancer-specific survivals were estimated using the Kaplan-Meier method. ResultsComplications were seen in nine patients (13.0%). After a mean follow-up of 6.2 yr (median, 5.8 yr) seven patients (10.1%) had died, none of them of tumour-related causes. Tumour recurrence was detected in four patients (5.8%). The 5-yr overall survival probability was 94.9%. The 10-yr and 15-yr overall survival rates were both 86.7%. Cancer-specific survival was 100% after 5, 10, and 15 yr. ConclusionsSelected patients with localized RCC even >4cm can be treated with elective NSS providing optimal long-term outcome. The surgeon’s decision for organ-preserving surgery should depend on tumour localisation and technical feasibility rather than on tumour size.
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