Nephron-sparing surgery for renal tumors.

Purpose: To report National Cancer Institute (NCI) experience in managing various benign and malignant renal tumors with nephron sparing surgery (NSS), and to assess its safety and feasibility.

Patients And Methods: Literature review for NSS, and reviewing of the patients records who underwent NSS between the period from January-2000 to December-2009 at NCI-Cairo University was done. Tumor related characteristics, indication for NSS, operative techniques, postoperative complications, full histopathological data, and follow up results were reviewed.

Results: The total number of patients was 15. Median age at surgery was 32 years (range from 1.5 to 65 years). Five patients had bilateral tumors. The mean radiologic tumor size was 4.7±5.2cm. All patients had normal preoperative kidney functions. Six patients had an absolute indication for NSS, while 6 patients had a relative indication, and 3 patients were elective. All 5 patients with bilateral tumors underwent bilateral simultaneous surgery. Cold ischemia was used in 7 patients, 1 patient was exposed to warm ischemia. Manual compression was used in 2 patients, and no vascular control was applied in 5 patients. Complications were encountered in 2 patients, one of them had urinary leakage which needed reoperation, and the other had subcutaneous hematoma which was treated conservatively. Histopathological analysis revealed Wilm's tumor (7 patients), angiomyolipoma (4 patients), renal cell carcinoma (RCC) (3 patients), and Hydatid cyst (1 patient). All patients had negative surgical margin. For patients with Wilm's tumor, the median follow up was 24.4 months (range from 5 to 94 months), two patients had local recurrence, and 1 patient had distant metastasis. For patients with RCC, The median follow up was 14.7 months (range from 5 to 33 months) with no local recurrence or distant metastasis. All patients had normal kidney functions during postoperative and follow up periods.

Conclusion: NSS is a feasible safe procedure that could be done with acceptable complications. It provides a good solution for patients with bilateral benign tumors and early localized RCC.