The clinical application of nephron-sparing surgery(NSS)in selective T2 renal cell carcinoma

Abstract

Objective To investigate the safety and efficacy of nephron-sparing surgery(NSS)for selective T2 stage renal tumor. Methods The surgical database of 26 patients treated with NSS for clinical T2 stage renal cell carcinomas between March 2010 and May 2013 were collected and analyzed retrospectively. There were 17 males and 9 females, with a mean age of 52 years (39-74 years), mean tumor size of 10.3 cm(7.2-16.5 cm), and mean R. E.N.A.L score of 7.5 (6-10). Patients' demographics, clinical characteristics, oncologic outcomes, renal function were reviewed. Results The renal masses were removed successfully and the surgical margins were negative. There were 21(80.8%)cases of clear cell carcinoma, 4 (15.4%) papillary carcinoma and 1(3.8%)chromophobe carcinoma. The mean ischemia time was (28.3±12.5) minutes (7 patients were clamp-free). Three patients needed transfusion, one experienced urine fistula and cured by conservative treatment, and one patient's renal function got progressive worsening and required long-term hemodialysis. The average serum creatinine was 121 μmol/L before and 136 μmol/L after surgery (P=0.06). After a period of 22-47 months' follow-up, no patient had local recurrence or metastasis. Conclusions NSS can be safely performed and provide effective oncologic outcomes for selective patients with clinical T2 stage renal cell carcinomas. R. E.N.A.L nephrometry is an important factor and should be used to evaluate the feasibility of NSS. Key words: Kidney neoplasms; Nephron-sparing surgery(NSS); Clinic outcome; Renal function