Nephron-Sparing Surgery versus Radical Nephrectomy in the Treatment of Intracapsular Renal Cell Carcinoma up to 7 cm

Objective: To compare the oncologic outcomes of nephron-sparing surgery versus radical nephrectomy in intracapsular renal cell carcinoma (RCC) up to 7 cm by reviewing surgical experience retrospectively. Methods: Data from 1290 consecutive patients who had surgery for RCC have been stored in a dedicated database since 1983. We selected and reviewed those related to disease-free patients who had been treated for unilateral pT1a/pT1b pN0/Nx M0 carcinomas up to 7 cm and later followed for a minimum of 12 mo. Results: A total of 642 patients with mean follow-up of 72.9 mo were selected; 313 had been treated for tumours <4 cm in diameter (176 nephron-sparing surgery, 137 nephrectomy), whereas 329 had been treated for tumours measuring ≥4 cm (52 nephron-sparing surgery, 277 nephrectomy). The comparison between tumours <4 cm or ≥4 cm in diameter showed worse progression and disease-free survival rates for the latter, but the type of surgery (nephron-sparing or radical) seemed to have no significant impact. Conclusions: Conservative management can be cautiously suggested for RCC up to 7 cm because the worsening of prognosis as diameter increases shows no statistical differences for either nephron-sparing or radical surgery. The agreement of our results with those of similar studies available in the literature may suggest designing a prospective study to compare conservative and more radical surgery in the management of RCC up to 7 cm. © 2007 European Association of Urology.