Nephron sparing surgery of parenchymal kidney tumours in solitary kidney.
The aim of this study is to assess the therapeutic efficacy of nephron sparing surgery (NSS) in our experience applied to patients with either bilateral renal cancer or patients with cancer in a solitary functioning kidney, from an oncological viewpoint as well as renal function. From January 1997 to March 2006 we submitted 185 patients to NSS. Twenty-seven presented absolute indications with disease in functionally or anatomically solitary kidney. All but six patients presented with preoperative creatinine levels lower than 2 mg/dL. Access was always lombotomic. Nineteen patients underwent renal artery clamping and cold ischemia. Lesions were between 2 and 14 cm in size. In six cases the collecting system was formally opened. Follow-up was between 2 and 108 months. Final histology showed 17 patients with clear cell renal carcinoma, six papillary cell carcinomas, one chromophobe carcinoma, one oncocytoma and two angiomyolipomas. No major perioperative complications were recorded. Two patients died of lung metastases. Two patients present secondary tumours (lung and liver), whereas one patient is being treated with chemotherapy for colon cancer Twenty-two patients are disease-free. None of the 10 patients discharged with creatinine levels >2 mg/dL, were submitted to dialytic therapy during follow-up. None of the patients discharged with normal renal function developed kidney failure. Conservative surgery for patients with absolute indications, is a valid alternative to radical surgery that obviously commits patients to long-term dialysis or renal transplantation. Our cases showed minimal surgical complications, brief hospital stay and limited invasiveness for patients with small incidence of kidney failure associated to the all important cancer control.