SIMPLE ENUCLEATION FOR THE TREATMENT OF RENAL CELL CARCINOMA BETWEEN 4 AND 7 CM IN GREATEST DIMENSION: PROGRESSION AND LONG-TERM SURVIVAL

INTRODUCTION & OBJECTIVES: We present our findings in a series of patients treated by simple enucleation for renal cell carcinoma (RCC) of 4-7 cm in greatest dimension and specifically report on the incidence of local and systemic recurrence and disease-specific survival rate. MATERIAL & METHODS: We retrospectively reviewed the clinical and pathological data of 71 patients who underwent nephron sparing surgery (NSS) by simple enucleation between 1986 and 2004 for sporadic, unilateral, pathologically confirmed, 4-7 cm RCC. Patients with solitary kidney due to previous RCC treated by radical nephrectomy were excluded from the study. None of the patients had pre- or intra-operative suspicion of positive nodes. All patients were free from distant metastases before surgery (MO). The patients' status was evaluated last in May 2005. The mean (median, range) follow up was 74 (51, 12-225) months. RESULTS: The pathologic review according to the 2002 TNM classification showed that 42% (30/71) tumours were pTla, 44% (31/71) pT1b, and 14% (10/71) pT3a. The mean (SD, median, range) tumour greatest dimension was 4.7 (0.81, 4.5, 4.0-7.0) cm. None of the patients died within the first 30 days of surgery. There were no major complications such as bleeding and urinary leakage/urinoma requiring reoperation. The 5- and 8-year cancer specific survival was 85.1% and 81.6%, respectively and the 5-year cancer specific survival for pTla (4 cm), pTlb and pT3a patients was 95.7%, 83.3% and 58.3%, respectively (pTla vs. pTlb p=0.254; pTla vs. pT3a p=0.006, pTlb vs. pT3a p=0.143). Overall,10 patients experienced progressive disease (14.9%) of whom three had local recurrence (4.5%) either alone or associated with distant metastases. CONCLUSIONS: Simple tumour enucleation is a useful and acceptable approach for NSS for RCC of 4-7 cm, provides long-term cancer-specific survival rates similar to radical nephrectomy and is not associated with a greater risk of local recurrence than is partial nephrectomy for RCC of < 4 cm in greatest dimension.