Elective conservative surgery for renal carcinoma versus radical nephrectomy: a prospective study.

Abstract OBJECTIVE: To identify criteria with which to select candidates for conservative nephrectomy, and to compare the results of radical and conservative nephrectomy in two homogeneous groups of patients with renal carcinoma, in a prospective study. PATIENTS AND METHODS: Forty patients (27 men and 13 women, mean age 49.9 years, range 23-76) with renal carcinoma (T1-T2 NOMO, < 4 cm in diameter) were enrolled in the study between 1988 and 1993 and followed for a maximum of 98 months (mean 70.1). The patients were divided into two groups: Group A comprised 19 patients (mean age 51.4, SD 13.7 years, mean tumor size 3.34, SD 0.64 cm) who underwent partial nephrectomy: Group B comprised 21 patients (mean age 48.7, SD 14.7 years, mean tumour size 3.21, SD 0.56 cm) who were selected for radical nephrectomy. The survival and progression of disease were assessed. RESULTS: Survival did not differ between the groups; one patient from each group died from distant metastases. There were no cases of local recurrence and multifocal neoplastic lesions were found in one patient during surgery. CONCLUSION: This prospective study confirms the results of retrospective studies that conservative surgery is as effective as radical surgery for renal carcinoma; however, its clinical application is limited by the risk that the renal carcinoma is multifocal.