title: Comparison of long-term results after nephron-sparing surgery and radical nephrectomy in treating 4- to 7-cm renal cell carcinoma.
abstract: OBJECTIVE
  The aim of our study was to compare long-term oncological outcomes following nephron-sparing surgery (NSS) and radical nephrectomy (RN) for renal cell carcinoma (RCC) 4 to 7 cm in diameter.
  
  
  METHODS
  The study included patients who underwent RN or NSS for RCC 4 to 7 cm in diameter between 1998 and 2009. The studied groups were compared with respect to the patients' age, sex, physical status according to the American Society of Anesthesiologists Physical classification, histological type, stage, tumor size, grade, duration of the operation, and complications. Survival was established using the Kaplan-Meier method. The risk factors for survival were analyzed using a multivariate Cox regression model.
  
  
  RESULTS
  During the study, 351 patients underwent surgery: 317 patients (90.3%) underwent RN, and 34 (9.7%), NSS. The compared groups differed with respect to tumor size (P=0.001) and stage (P=0.006). The overall estimated 12-year survival was 53.7% after RN and 55.2% after NSS (log-rank test P=0.437). The 12-year cancer-specific survival in the RN and NSS groups was 69.6% and 80.6%, respectively (log-rank test P=0.198). Pathological stage and patients' age were the major factors affecting both overall and cancer-specific survival. The type of surgery (NSS or RN) had no effect on survival.
  
  
  CONCLUSIONS
  Our study showed that nephron-sparing surgery is a safe technique compared with radical nephrectomy that ensures good oncological control in the treatment of renal cell carcinoma measuring 4 to 7 cm and may be proposed as the treatment of choice for renal tumors not only up to 4 cm, but also 4 to 7 cm in size.
authors.affiliation: Department of Urology, Me-di-cal Academy, Lithuanian University of Health Sciences, Eive-nių 2, 50028 Kaunas, Lithuania. daimantas.milonas@kaunoklinikos.lt.
authors.forename: Daimantas
authors.initials: D
authors.lastname: Milonas
authors.forename: Giedrius
authors.initials: G
authors.lastname: Skulčius
authors.forename: Ruslanas
authors.initials: R
authors.lastname: Baltrimavičius
authors.forename: Stasys
authors.initials: S
authors.lastname: Auškalnis
authors.forename: Marius
authors.initials: M
authors.lastname: Kinčius
authors.forename: Aivaras
authors.initials: A
authors.lastname: Matjošaitis
authors.forename: Inga
authors.initials: I
authors.lastname: Gudinavičienė
authors.forename: Giedrė
authors.initials: G
authors.lastname: Smailytė
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Jievaltas
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery*; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors