Surgical enucleation for renal cell carcinoma (RCC). Prognostic significance of tumour stage, grade and DNA ploidy.
This study reviews a total of 26 renal cell carcinoma (RCC) who underwent enucleation of the tumour with functionally and anatomically normal controlateral kidney and no evidence of systemic renal disease. At follow-up, after a mean of 62 months the disease specific survival rate for this series was 88.5%. Survival rates according to the pathologic stage, grading, tumour diameter and ploidy are reported. Local recurrences were documented in 4 of the 26 RCC. All 4 RCC were more than 5 cm in diameter and recurred in the remaining parenchyma. After local recurrence, three tumours with aneuploid DNA content underwent radical nephrectomy, whereas 1 with diploid DNA content was submitted to a new enucleation of the recurrence. To date the diploid case is still alive 3 years after the original resection of the primary tumour whereas the other 3 patients died for metastatic disease. In our experience the ideal candidate for renal sparing surgery in the presence of a normal opposite kidney is an asymptomatic patient that incidentally is brought to our attention with a small size (less than 5 cm in diameter), low stage (T1-T2) tumour, well surrounded by a pseudocapsule. DNA content is a valuable prognostic factor in patients submitted to conservative surgery. Diploid tumours have been seen to have a better prognosis and in case of local recurrence they may be reconsidered for a new enucleation of the recurrence.
Di Silverio
F
F
Department of Urology U. Bracci, University La Sapienza, Rome, Italy.
Sciarra
A
A
Flammia
G P
GP
Mariani
M
M
De Vico
A
A
Buscarini
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011003:Ploidies; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D015996:Survival Rate
D004273:DNA, Neoplasm