The value of nephron-sparing surgery for the treatment of renal cell carcinoma 4 to 7 cm in size.

Nephron-sparing surgery (NSS) is a treatment of choice for renal cell carcinoma (RCC) less than 4 cm. in size. However its efficacy in the treatment of RCC from 4cm to 7 cm is not well defined and is still controversial. We retrospectively reviewed the records of 57 patients who underwent NSS at our institution for RCC of 4-7 cm in size, from 1994 to 2011. NSS was done by means of enucleoresection and/or eucleation. The mean follow-up was 70.1 months (range: 10-157 months). Mean patient age was 53.1 years. NSS was performed for absolute indications in 5 (8.8%), for relative indications in 11 (19.3%) and for elective indications in 41 (71.9%) patients. The tumour size was significantly higher in the patients with absolute indication as compared with the patients operated for relative and elective indications (p<0.04). The difference between the later two groups was not significant. The tumour recurred in 6 (10.5%) patients. Of them, local recurrence was detected in 2 (3.5%) and systemic recurrence in 4 (7%) patients. At the end of follow-up overall survival was 85.8%, disease-free survival was 82.4%. Both, overall and disease-free survivals were significantly better in the patients operated for relative and elective indications as compared to absolute indication (p<0.014 and p<0.023, respectively). NSS is a feasible procedure for RCCs 4 cm to7 cm in size. Local cancer control can be achieved in most patients. Oncological outcome was negatively related with the tumor size. Long-term prospective studies are required to prove the similar oncological efficacy of NSS and radical nephrectomy (RN) in RCC of 4 cm to7 cm in size.