[Conservative surgery for kidney cancer: Indications and results based on a review of 40 patients].
OBJECTIVE
To evaluate the oncological and functional results in patients treated by conservative surgery for kidney cancer and to study the intraoperative and postoperative morbidity.


METHODS
Retrospective, single-centre study based on 40 consecutive patients undergoing a conservative surgery for kidney cancer between March 1997 and July 2006. Patients had a mean age of 60 years (range: 26-81 years) and the surgical indication was elective in 75% of cases (n=30) and mandatory in 25% of cases (n=10). Preoperative mean creatinine and creatinine clearance were 101mol/l (53-237mol/l) and 80ml/min (35-147ml/min), respectively. Tumours were classified according to the TNM 2002 classification as stage T1a (75%), T1b (20%) and T2 (5%). Guided kidney aspiration biopsy was performed in 80% of patients. The main endpoints were positive surgical margins, local recurrence, intraoperative complications and postoperative renal function. Secondary endpoints were postoperative complications, need for blood transfusion, surgical revision, operating time and hospital stay, metastatic disease and overall and specific survival. Statistical analysis was performed with SPSS 13.0.1 software.


RESULTS
With a mean follow-up of 44 months (range: 15-134 months), one patient (2.5%) presented local recurrence. The positive surgical margin rate was 5% and overall and specific survivals were 97.5%. No metastases have been observed. Serum creatinine was increased and creatinine clearance was significantly decreased (P<0.05) after the operation, with no clinical consequences. The urinary fistula rate was 5%, blood transfusion and surgical revision were required in 5% of cases respectively, the mean operating time was 128minutes and the mean hospital stay was 8.1 days.


CONCLUSIONS
Mandatory, relative or elective conservative kidney surgery gives functional and oncological results at least equivalent to those of radical nephrectomy, with the advantage of nephron-sparing surgery. It should be suggested as first-line procedure whenever possible, even when the contralateral kidney is healthy.
Arroua
F
F
Service d'urologie, CHU Nord, chemin des Bourrelys, 13015 Marseille, France. frederic.arroua@ap-hm.fr
Carcenac
A
A
Tomatis
L
L
Ragni
E
E
Rossi
D
D
Bastide
C
C