Nephron-sparing surgery for renal cell carcinoma: State of the art and 10 years of multicentric experience

Objectives: The natural history of renal cell carcinoma (RCC) has changed dramatically in the last two decades. The rising incidence of small renal lesions and advances in surgical techniques have led urologists to perform nephron-sparing surgery (NSS) more frequently and also to extend its indication to elective conditions. We review the state of the art of NSS for RCC and report a multicentric experience at four Italian urologic departments. Methods: We used the Medline database to collect relevant reports on NSS. We critically reviewed and evaluated the data of patients who underwent open partial nephrectomy between 1994 and 2004 at four Italian urologic centres, namely, Genoa, Bologna, Trieste, and Savona. A final cohort of 360 patients, with a mean follow-up of 55.3 mo who underwent NSS mainly for elective conditions (72.1%), was statistically evaluated. Results: NSS is a successful treatment for patients with localised RCC for both elective and imperative conditions, providing the same excellent long-term results as radical surgery in selected patients. The surgical complications of NSS have continued to decline in the last three decades. In our population, the 5- and 10-yr cancer-specific survival rates were 96.6% and 86.9%, respectively. Conclusions: Open conservative surgery represents a safe and effective treatment for small renal tumours. New minimally invasive nephron-sparing techniques are currently being developed and will certainly evolve in the near future. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.