The role of renal-sparing surgery for renal cell carcinoma.

Nephron-sparing surgery provides effective therapy for patients with localized RCC in whom preservation of renal function is a relevant clinical consideration. The technical success rate with this approach is excellent, and long-term patient survival free of cancer is comparable with that obtained after radical nephrectomy, particularly for stage I RCC. The major disadvantage of conservative surgery is the approximately 10% risk of postoperative local tumor recurrence. The risk of local recurrence after radical nephrectomy has not been determined but is presumably less. The indications for nephron-sparing surgery in patients with unilateral RCC and a completely normal opposite kidney are not established, and radical nephrectomy should still be considered the treatment of choice in this setting.