[Nephron-sparing surgery for localized kidney neoplasms--a report of 25 cases].

BACKGROUND & OBJECTIVE: Nephron-sparing surgery (NSS) was initially used in treating bilateral renal cell carcinoma (RCC) or RCC in a solitary functioning kidney with good effectiveness. The satisfied long-term outcome was also obtained in patients with unilateral localized RCC and a normal contralateral kidney after NSS. This paper was to report our experiences in treating localized renal tumor with NSS.

METHODS: From Nov. 1999 to Dec. 2004, 25 patients were diagnosed with localized RCC preoperatively, and treated with NSS. During operation, renal circulation was temporarily interrupted in 8 patients, surface cooling of the kidney with ice slush was performed in 3 patients, frozen section pathology was performed in 16 patients.

RESULTS: The operation was technically successful in all cases. The median operating time was 129 min (ranged 65-205 min). The mean blood loss was 310 ml (ranged 100-800 ml) with 1 case of blood transfusion. Except for 1 case of urinary fistula which was cured conservatively, there was no other postoperative complication. Intraoperative pathology confirmed that the surgical margin of all cases were negative. Of the 25 cases, 19 were renal clear cell carcinoma, 2 were renal granular cell carcinoma, 4 were hamartoma. The pathologic stage was pT1N0M0 in 21 patients. The mean follow-up time was 22 months (ranged 6-55 months). No local tumor recurred, and all patients survived disease-freely.

CONCLUSIONS: NSS is effective in treating localized RCC. We recommend NSS to patients with unilateral localized, but not center, kidney tumor less than 4 cm and a normal contralateral kidney.