[Does technical progress mean clinical advantage? Analysis of clinical and histopathological parameters of renal cell carcinomas in long-term course].
OBJECTIVE
Renal cell carcinoma is the third most frequent urogenital malignancy. The increased incidence in the past few years can be attributed in particular to increased incidental findings since the introduction of routine ultrasound and radiological imaging. In the current contribution we analyse in a long-term approach the actual impact of these advances on indications for surgical management.


METHODS
From January 1992 until December 2007, 1,113 renal cell carcinoma patients underwent a total of 1,129 surgical interventions in our department. Retrospectively, we collected the clinical and histopathological data of these patients, comparing them in terms of the entire study period and the four 4-year time spans 1992-1995, 1996-1999, 2000-2003 and 2004-2007.


RESULTS
59 % of the patients were male, the median age being 64 years [range: 26-91 years]. In the study period, the number of patients <or= 45 years and > 75 years increased statistically significantly (p = 0.012). The number of incidental findings -remained constant at approximately 72 %, while that of patients who had received preoperative cross-sectional imaging diagnostics rose statistically significantly from 88 % to 98 % (p < 0.001). Tumours of stage pT1a increased statististically significantly to 42 %, the number of partial renal resections in the same period to 25 % (p < 0.001). There was no difference in residual tumour rate between nephron-sparing surgery and tumour nephrectomy.


CONCLUSIONS
We were able to confirm that the major developments in the diagnostic and surgical approaches to renal cell carcinoma over the past few years do translate into clinical benefits for patients who are increasingly being subjected to partial renal resection.
Otto
Wolfgang
W
Caritas-Krankenhaus St. Josef, Klinik und Poliklinik für Urologie, Universität Regensburg, Regensburg. wolfgang1.otto@klinik.uniregensburg.de
Hübner
I
I
Burger
M
M
Rössler
W
W
Wieland
W F
WF
Denzinger
S
S
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D005858:Germany; D006801:Humans; D033162:Incidental Findings; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D009392:Nephrectomy / Q000379:methods; D011183:Postoperative Complications / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed