Department of Urology, University of Brescia, Brescia, Italy.

To compare the oncologic outcomes of nephron-sparing surgery versus radical nephrectomy in intracapsular renal cell carcinoma (RCC) up to 7cm by reviewing surgical experience retrospectively.

Data from 1290 consecutive patients who had surgery for RCC have been stored in a dedicated database since 1983. We selected and reviewed those related to disease-free patients who had been treated for unilateral pT1a/pT1b pN0/Nx M0 carcinomas up to 7cm and later followed for a minimum of 12 mo\

A total of 642 patients with mean follow-up of 72.9 mo were selected; 313 had been treated for tumours <4cm in diameter (176 nephron-sparing surgery, 137 nephrectomy), whereas 329 had been treated for tumours measuring >/=4cm (52 nephron-sparing surgery, 277 nephrectomy). The comparison between tumours <4cm or >/=4cm in diameter showed worse progression and disease-free survival rates for the latter, but the type of surgery (nephron-sparing or radical) seemed to have no significant impact.

Conservative management can be cautiously suggested for RCC up to 7cm because the worsening of prognosis as diameter increases shows no statistical differences for either nephron-sparing or radical surgery. The agreement of our results with those of similar studies available in the literature may suggest designing a prospective study to compare conservative and more radical surgery in the management of RCC up to 7cm.

Written by
Antonelli A, Cozzoli A, Nicolai M, Zani D, Zanotelli T, Perucchini L, Cunico SC, Simeone C.

Reference
Eur Urol. 2007 Nov 20 [Epub ahead of print]
doi:10.1016/j.eururo.2007.11.007

PubMed Abstract
PMID:18036730

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