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Annals of Surgical Oncology 9:680-687 (2002)
© 2002 Society of Surgical Oncology

ORIGINAL ARTICLES

Partial Nephrectomy: The Rationale for Expanding the Indications

Paul Russo, MD, Manlio Goetzl, MD, Rachel Simmons, MD, Jared Katz, MD, Robert Motzer, MD and Victor Reuter, MD

From the Departments of Urology (PR, MG, RS, JK), Medicine (RM), and Pathology (VR), Memorial Sloan-Kettering Cancer Center, New York, New York.

Correspondence: Address correspondence and reprint requests to: Paul Russo, MD, Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021; Fax: 212-717-3175; E-mail: russop{at}mskcc.org

Background: We report preliminary results of partial nephrectomy for renal tumors of >=4 cm in 39 patients with the intent of extending the indications for kidney-sparing surgery.

Methods: From July 1989 to October 2001, 39 patients underwent a partial nephrectomy for renal cortical tumors >4 cm in maximum diameter. Fourteen (36%) had the procedure performed for essential reasons, and 25 (64%) had an elective kidney-sparing operation. We evaluated tumor location and histology, perioperative renal function, and postoperative complications.

Results: There were 20 conventional clear-cell (51%), 13 papillary (33%), 4 chromophobe (10%), and 3 oncocytomas (8%) with a median tumor size of 5 cm. After a median follow-up of 13 months, 36 patients had no evidence of disease, 1 patient had died as a result of other causes, and 2 patients who had essential operations were alive with disease. Twenty-three patients (70%) maintained normal postoperative renal function. Of six patients with moderate preoperative renal dysfunction, five (83%) had no change in postoperative renal function and only one patient required short-term dialysis.

Conclusions: With careful patient selection, partial nephrectomy can be effectively used to treat patients with renal cortical tumors >4 cm in diameter. The benefits of this approach include the effective local tumor control while at the same time preserving maximum renal function.

Key Words: Partial nephrectomy • Kidney-sparing surgery • Renal tumors • Tumor staging






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