title: Elective nephron sparing surgery should become standard treatment for small unilateral renal cell carcinoma: Long-term survival data of 216 patients.
abstract: OBJECTIVE
  Our experiences with elective nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) in a consecutive series of 216 patients are presented. Clinicopathological features and long-term oncological outcome is compared to patients treated with radical nephrectomy (RN).
  
  
  METHODS
  Between 1975 and 2002, NSS was performed in 488 patients; 311 of these patients had elective indications. Renal cell carcinoma was found in 241/311 patients (77.5%). Long-term follow up data could be obtained in 216/311 patients. Cancer-specific survival was estimated using the Kaplan-Meier method. Cox's regression analysis and log-rank tests were used to evaluate independent predictive values of different clinicopathological features. Survival data of the 216 patients after NSS surgery were compared to 369 patients with small RCC treated with RN.
  
  
  RESULTS
  After a mean follow up of 66 months (median 64 months) 29 (13.4%) of 216 patients treated with NSS had died, 4 of them (1.8%) tumour-related. Tumour recurrence was detected in 12 patients (5.6%). 204 patients (94.4%) were free of tumour at last follow-up. Cancer specific survival rates at 5 and 10 years for patients treated with NSS (RN) were 97.8% (95.5%) and 95.8% (84.4%).
  
  
  CONCLUSIONS
  Elective NSS surgery provides optimal long-term outcome in patients with small localized RCC. Compared to RN, renal parenchyma is preserved without any disadvantage in survival rates. Consequently elective NSS should be accepted as gold standard for small renal tumours.
authors.affiliation: Department of Urology and Paediatric Urology, University of Saarland, Germany. frank.becker@uniklinikum-saarland.de
authors.forename: F
authors.initials: F
authors.lastname: Becker
authors.forename: S
authors.initials: S
authors.lastname: Siemer
authors.forename: U
authors.initials: U
authors.lastname: Humke
authors.forename: M
authors.initials: M
authors.lastname: Hack
authors.forename: M
authors.initials: M
authors.lastname: Ziegler
authors.forename: M
authors.initials: M
authors.lastname: Stöckle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000592:standards; D009399:Nephrons / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome