PROGRESSION AND LONG-TERM SURVIVAL AFTER SIMPLE ENUCLEATION FOR THE ELECTIVE TREATMENT OF PT1A RENAL CELL CARCINOMA (RCC): OUR EXPERIENCE OVER 25 YEARS

INTRODUCTION & OBJECTIVES: To present our findings in our series of pTla RCC treated by elective simple enucleation and to specifically report on the incidence of local recurrence, progression-free and disease-specific survival rate. MATERIAL & METHODS: 232 patients who had elective NSS performed by simple enucleation from January 1986 and September 2004 for sporadic, unilateral, pathologically confirmed, ≤ 4 cm RCC, were studied retrospectively. The patients' status was evaluated last in September 2005. The mean (median, range) follow up was 76 (61, 12-225) months. RESULTS: Mean (SD, median, range) tumour greatest dimension was 2.8 (0.78, 2.85, 0.6-4) cm. On the basis of Fuhrman nuclear grading 32.3% (75/232) of tumours were G 1 , 51.3% (119/232) G2 and 16.4% (38/232) G3/G4. The histopathologic review according to the new classification (UICC and AJCC 1997) revealed 198 clear cell (85.3%), 18 papillary (7.8%), 15 chromophobe (6.5%) and 1/232 (0.4%) collecting system RCC. None of the patients died in the immediate postoperative period. Twelve patients (5.2%) developed postoperative bleeding requiring transfusions and 6 (2.6%) had postoperative prolonged urinary leakage from the drainage requiring double-J stent insertion. There were no major complications, such as prolonged acute tubular necrosis/chronic renal insufficiency and bleeding requiring reoperation. The 5- and 10-year cancer specific survival was 96.7% and 94.7%, respectively. The 5- and 10-year progression free survival was 96% and 94%, respectively. Overall,13 patients experienced progressive disease (5.6%) of whom 5 (2.1%) had local recurrence either alone or associated with distant metastases. Three of these had local recurrence alone, elsewhere in the kidney, showing a "kidney" recurrence rate of 1.3%. CONCLUSIONS: We confirm on a larger series that simple tumour enucleation is a safe and acceptable approach for elective NSS, provides excellent long-term progression free and cancer specific survival rates and is not associated with an increased risk of local recurrence compared to partial nephrectomy