Partial nephrectomy for renal cell carcinoma with a normal opposite kidney.

Abstract

The role of nephron-sparing surgery in patients with unilateral renal carcinoma and a normal opposite kidney is controversial. The number and selection criteria of patients undergoing a partial nephrectomy versus radical nephrectomy from 1979 to 1991 were compared. Of 230 patients having curative surgery for unilateral renal cell carcinoma, 41 had a partial nephrectomy. The percentage of partial compared with total nephrectomies performed increased from 8% in 1979-84, to 20% in 1984-88, and 30% in 1989-91. The increased number of partial versus radical nephrectomies performed reflected an increased detection of small (3.5 cm) incidental renal tumors by radiologic imaging. The local recurrence rate was 2.4% (one patient), and the survival rate was 95% (average, 3 years). Complete local excision of the small serendipitous renal tumor is feasible and reasonable in the patient with an otherwise normal opposite kidney.