[Organ-preserving renal tumor surgery for renal cell carcinoma ≥T1b: operative technique, complications and oncological control].

BACKGROUND: Nephron sparing surgery (NSS) represents the recommended treatment of choice in guidelines for T1a and T1b renal tumors. Current data, however, suggest that approximately 60% of patients with T1b tumors are treated by radical nephrectomy. PATIENTS AND METHODS: We performed a retrospective analysis of 320 patients with renal cell cancer who underwent organ sparing procedures: NSS for renal tumors ≤4 cm (n=196, group 1) and 4.1-7 cm (n=92, group 2) as well as radiofrequency ablation (RFA, n=32, group 3). We analysed the indications, surgical techniques, perioperative complications and oncological outcome of the three groups.
RESULTS: There were significant differences between groups 1 and 2 with regard to mean tumor size (2.9 cm versus 8.6 cm, p=0.03), necessity for warm ischemia (15.1% versus 51%, p=0.001), mean time of warm ischemia (3.5 min versus 10.2 min, p=0.002), necessity for endoluminal stenting due to involvement of the renal collecting system (0.5% versus 24.2%, p=0.001) and the number of pT2 (12.7% versus 29.7%, p=0.03) and pT3 tumors (8.7% versus 12%, p=0.05). In group 3 the mean age was 69.2 years and the mean Charlson comorbidity score was 7.7 (range 3-12) as compared to 3.4 (1-6) in groups 1 and 2. After a mean follow-up of 32 (2-71) months, 2 (6.2%) local recurrences developed and 8 patients died, 6 patients due to comorbidities and 2 patients due to metastatic renal cell carcinoma (RCC).
CONCLUSIONS: Nephron sparing surgery can be safely performed for T1a to T2a renal cell carcinoma with equivalent oncological outcomes as compared to radical nephrectomy. Nephron sparing surgery should represent the standard surgical approach for localized RCCs independent of size and RFA should be reserved for patients with significant comorbidities.