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RESEARCH PRODUCT

Conservative Surgery of Renal Tumors: Operative Technique, Complications, Results, DNA Cytometry

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Until now radical nephrectomy has been regarded as the standard therapy for nonmetastasized renal cell carcinoma. This operation has been accepted because of the theoretical advantage of a more complete resection. A parenchyma-sparing operation was only performed in patients in whom radical nephrectomy would result in renal failure requiring hemodialysis (imperative indication), such as patients with single kidney, bilateral tumors, dysfunctional contralateral kidney, or chronic renal failure. However, the widely used partial nephrectomy in these instances may in certain cases result in insufficient residual renal parenchyma. Simple enucleation of the tumor with a small surrounding margin of normal renal tissue is an alternative technique to this approach. The surprisingly good prognosis of patients who were treated by enucleation in the imperative group [1] has encouraged us over the past 9 years to perform parenchyma-sparing operations also in patients with small peripheral tumors and normal contralateral kidneys (elective indication). Moreover, these small and mostly asymptomatic kidney tumors which only a few years ago were rarely diagnosed, are being detected more frequently by ultrasound. Thus, the incidence of asymptomatic renal tumors increased from 10% in 1978 to 70% in 1989, while the classic symptoms of flank pain, hematuria and palpable mass were found in less than 10% of the cases. In this chapter we present the operative technique, complications, patient outcome, and preliminary results of image analysis DNA cytometry.