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[Long-term oncological results after conservative surgery for unifocal renal cancer].

OBJECTIVE
To evaluate the risk of local recurrence and metastatic spread of renal cancer treated by conservative surgery with a minimum follow-up of 5 years.


MATERIAL AND METHODS
All patients operated for renal cancer by conservative surgery in our department between November 1989 and March 1997 were included in this retrospective study and were submitted to annual follow-up. These patients presented conventional indications (solitary T1N0M0 tumours < 4 cm) or indications of necessity (all stages).


RESULTS
The minimum follow-up was 5 years (range: 63-143 months; median: 90 months). This series comprised 30 partial nephrectomies, 15 performed for solitary T1N0M0 tumours < 4 cm, and conservative surgery was performed by necessity in 15 patients (10 patients with T1N0M0 tumours, 5 patients with T2 or M+ tumours). All tumours less than 4 cm on imaging were less than 4 cm on the operative specimen. In stage T1N0M0 tumours, the prediction of pathological stage by preoperative imaging was accurate in 24 out of 25 cases, with 24 pT1N0M0 and 1 pT3aN0M0 on final histology. The resection margins were negative in 29 out of 30 patients. One patients with a stage T2N0M+ tumour (7.5 cm in diameter) had a positive resection margin. Two out of 30 patients developed impaired renal function after surgery to a solitary kidney. Renal function at 3 months remained identical to preoperative renal function in all other patients. For 24 patients with pT1N0M0 tumours < 4 cm, the specific recurrence-free survival was 100% (median follow-up: 90 months; range: 63 to 143 months). Among the 6 patients with T2 or M+ tumours, 5 patients (84%) died from metastatic disease at 18, 22, 24, 28 and 54 months, while 1 patient (16%) was still alive without recurrence at 119 months.


CONCLUSION
The indication for conservative surgery for T1N0M0 renal tumours < 4 cm is a validated treatment option for unifocal renal cancer. This series confirms the data reported in the literature with a minimum follow-up of 5 years. Stage pT3a tumours on postoperative diagnosis have a high risk of recurrence and metastatic spread, which may constitute an indication for secondary radical nephrectomy. Annual surveillance by imaging is essential.