Nephron-Sparing Surgery in Renal Cell Carcinoma: Morbidity and Outcomes

• Marcos F. Dall’Oglio

  Division of Urology of the University of São Paulo Medical School, and Department of Uro-Oncology of the São Paulo State Cancer Institute, São Paulo/SP, Brazil

• Alexandre Crippa

  Division of Urology of the University of São Paulo Medical School, and Department of Uro-Oncology of the São Paulo State Cancer Institute, São Paulo/SP, Brazil

• Jose Roberto Colombo Junior

  Division of Urology of the University of São Paulo Medical School, and Department of Uro-Oncology of the São Paulo State Cancer Institute, São Paulo/SP, Brazil

• Rafael F. Coelho

  Division of Urology of the University of São Paulo Medical School, and Department of Uro-Oncology of the São Paulo State Cancer Institute, São Paulo/SP, Brazil

• Eder Nisi Ilário

  Division of Urology of the University of São Paulo Medical School, and Department of Uro-Oncology of the São Paulo State Cancer Institute, São Paulo/SP, Brazil

• Miguel Srougi

  Division of Urology of the University of São Paulo Medical School, and Department of Uro-Oncology of the São Paulo State Cancer Institute, São Paulo/SP, Brazil

 Objective: To present the partial nephrectomy series performed at our institution.

Patients and Methods: 147 patients underwent nephron-sparing surgery between Jan/2000 and Feb/2011. The mean patient age was 60.3 yrs (33.2-82.7), and 90 (61.2%) were men. The clinical presentation, pathological tumor features, perioperative complications, functional and oncological outcomes were analyzed.

Results: 84.4% of the renal masses were incidental, and the mean tumor size was 3,63 cm. Median warm ischemia time and estimated blood loss was 18 min (11-27) and 220 ml (50-480), respectively. Overall complication rate was 5%. 87.0% of the tumors were pT₁, 5.7% were pT2, and 7.3% was pT3. 45 tumors were high-grade (30.6%), microvascular invasion was observed in eleven tumors (7.5%), presence of necrosis occurred in twenty-seven tumors (18.4%), and invasion of perirenal fat was identified in ten cases (6.8%). At a mean follow-up of 60 months, local recurrence was observed in only six cases (4.1%) and the cancer-specific survival in this series was 95.2%.

Conclusion: Open partial nephrectomy is safe and presented optimal oncological results. It should be used for treating small renal tumors whenever is technically feasible.

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