Nephron-sparing surgery.
This retrospective study examines partial nephrectomies performed over a period of approximately three years to confirm the feasibility of the procedure for suspected renal cell carcinoma. The surgeries were done primarily at a 1000-bed, university-affiliated hospital by members of a private urologic surgery practice. We examined whether recent advances in diagnosis and surgical therapy increased the viability of partial nephrectomy as an alternative to radical nephrectomy in certain carefully selected patients. Patients underwent preoperative evaluation to confirm suitability for partial nephrectomy. Surgeons used an extraperitoneal approach and mobilized the kidney after incising Gerota's fascia. Nearly one-third of the procedures involved renal cooling. Because three masses turned out to be benign cysts, and one tumor was an oncocytoma, four patients with benign disease were spared unnecessary radical nephrectomy. With an average follow-up of 32 months, all patients remain free of disease and are not dependent on dialysis. Our findings are consistent with those of national studies that show partial nephrectomy does not compromise disease-free survival in properly selected patients. The success of nephron-sparing surgery in this sample opens the door for exploration of more advanced, less invasive techniques for management of renal cell carcinoma.