title: Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm.
abstract: OBJECTIVE
  Elective nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) < 4 cm has been accepted as alternative to radical nephrectomy (RN). However, NSS for tumours > 4 cm is controversial. We present our experiences and long-term oncologic outcome of RCC > 4 cm treated with NSS in a retrospective single-institutional analysis of 69 patients.
  
  
  METHODS
  Between 1975 and 2004, elective NSS was performed in 368 patients at our institution, including 69 patients with sporadic, nonmetastatic RCC > 4 cm. Overall and cancer-specific survivals were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Complications were seen in nine patients (13.0%). After a mean follow-up of 6.2 yr (median, 5.8 yr) seven patients (10.1%) had died, none of them of tumour-related causes. Tumour recurrence was detected in four patients (5.8%). The 5-yr overall survival probability was 94.9%. The 10-yr and 15-yr overall survival rates were both 86.7%. Cancer-specific survival was 100% after 5, 10, and 15 yr.
  
  
  CONCLUSIONS
  Selected patients with localized RCC even > 4 cm can be treated with elective NSS providing optimal long-term outcome. The surgeon's decision for organ-preserving surgery should depend on tumour localisation and technical feasibility rather than on tumour size.
authors.affiliation: Department of Urology and Paediatric Urology, Homburg, University of the Saarland, Germany. frank.becker@uniklinik-saarland.de
authors.forename: Frank
authors.initials: F
authors.lastname: Becker
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
authors.forename: Markus
authors.initials: M
authors.lastname: Hack
authors.forename: Ulrich
authors.initials: U
authors.lastname: Humke
authors.forename: Manfred
authors.initials: M
authors.lastname: Ziegler
authors.forename: Michael
authors.initials: M
authors.lastname: Stöckle
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors