Objective: A retrospective study on the nephron-sparing surgical treatment in patients with renal tumors, and in addition a literature review on the subject.
Material and methods: Since January 1988 until February 2002, 44 partial nephrectomies have been carried out in our unit because of renal tumors in 43 patients. The clinical protocols of these 43 patients have been reviewed, with an analysis of various clinical-pathological parameters, and utilizing in this analysis percentages, central tendency measures and dispersion and confidence intervals.
Results: The average age of the patients was 55.8 years (19-76), and 29 patients were males. Elective partial nephrectomy was carried out in 79.5% of the patients, while in the rest they were submitted to imperative surgery for various causes. The diagnosis of the tumors was mostly as an incidental finding upon carrying out some diagnostic test by another cause (68.2%). In the symptomatic cases, the most common presentation was the combination of pain and hematuria (11.4%). Histopathological study revealed malignant neoplasms in 88.7%, most of them (61.4%) clear cell carcinomas. A Furhman grade 2 was observed in 76.3% of tumors. The average size of the renal masses was of 4.53 cm (1,5-11). As a whole, 61.5% were pT1, 33.3% were pT2 and only one case was pT3. Operative complications were observed in 11.4% of the cases and postoperative complications in 25%. No patient showed local or distant recurrence, and all of them survived disease-free. A patient died after 74 months of the surgery for causes not related to the disease. Average follow-up was 49.77 months (1-168).
Conclusions: Renal nephron-sparing surgery is such a valid therapeutic option as radical nephrectomy in selected patients with renal tumors, since the cancer-specific survival is 100%, which means that this can be considered a therapeutic indication even in patients with healthy contralateral kidney.