Impact of elective versus imperative indications on oncologic outcomes after open nephron-sparing surgery for the treatment of sporadic renal cell carcinomas.

Purpose: To determine the effect of nephron-sparing surgery (NSS) on cancer control in renal cell carcinomas (RCC) and to compare the outcomes of patients who had elective versus imperative indications for surgery.

Methods: We performed a retrospective review of the data for patients treated with open NSS between 1980 and 2005 for sporadic RCCs. The following data were analyzed: age, intraoperative parameters, tumor size, Fuhrman grade, tumor, node, metastasis system disease stage, pathological data, and outcome.

Results: A total of 155 patients with a median age of 60 years were included. The mean preoperative and postoperative creatinine levels were 1.1 ± 0.3 mg/dl (range 0.6-2.6 mg/dl) and 1.2 ± 0.4 mg/dl (range 0.5-3.4 mg/dl), respectively. The mean tumor size was 3.8 ± 2 cm (range 1-10 cm). Margin status was positive in 15 cases (9.70%), and multifocal RCCs were observed in 36 patients (23.2%). Overall, NSS indications were elective in 96 cases (61.9%) and imperative in 59 cases (38.1%). Univariate analysis found that elective cases were associated with better perioperative outcomes (P = 0.01). In univariate analysis, tumor, node, metastasis system disease stage, multifocality, and indication were associated with recurrence (P < 0.05). In the multivariate analysis, only multifocality status and imperatives indications were significant (P < 0.05). The mean follow-up was 118.2 ± 151 months. The 5- and 10-year tumor-free survival rates were 81.8% and 78.7% in elective and imperatives cases, respectively.

Conclusions: Oncologic control seems to be better for cases of elective open NSS. Thus, NSS should be advocated as soon as it is technically possible, regardless of the size of the tumor.