title: Partial nephrectomy: the rationale for expanding the indications.
abstract: BACKGROUND
  We report preliminary results of partial nephrectomy for renal tumors of > or =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.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. russop@mskcc.org
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
authors.forename: Manlio
authors.initials: M
authors.lastname: Goetzl
authors.forename: Rachel
authors.initials: R
authors.lastname: Simmons
authors.forename: Jared
authors.initials: J
authors.lastname: Katz
authors.forename: Robert
authors.initials: R
authors.lastname: Motzer
authors.forename: Victor
authors.initials: V
authors.lastname: Reuter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D009519:New York City / Q000453:epidemiology; D018579:Patient Selection; D015996:Survival Rate