2006 - UZ Leuven

literature on nephron-sparing surgery was reviewed in order to put themanagement of renal cancer into a modern perspective.JONIAU S., VAN POPPEL H.: Nephron-sparing surgery: experience in159 consecutive cases. Eur. Urol. Suppl., 2006; 5(2): 182 (640).Introduction & Objectives: As a result of the widespread use ofultrasound, CAT scan and MRI, the majority of Renal Cell Cancer(RCC) is nowadays detected at an early stage. Nephron springsurgery has become an accepted treatment for small RCC. We reviewour experience in nephron sparing surgery for T1 and T2 lesions overthe last 5 years. The aim is to evaluate the feasibility and the safety ofthe technique and to assess oncological control.Material & Methods: Between July 1998 and July 2003, 159consecutive patients underwent nephron sparing surgery for T1 andT2 lesions at our institution. Mean age was 59 (2-82) years, meantumour volume was 4 (1-11) cm, mean follow-up 32 (5-65) months.Clinical stage was T1a in 77n4%, T1b in 19,5% and T2 3,1%. 69%had a normal contralateral kidney, 23% a solitary kidney and 8% hadbilateral tumours. Mean operating time was 91 minutes, 23% a solitarykidney and 8% had bilateral tumours. Mean operating time was 91minutes, mean blood loss 342 ml. Clamping was performed in 32,7%with a mean duration of 15 minutes. In 5% renal cooling wasperformed. There was an endorenal growth in 10,7%, a combinedgrowth in 43,4%, and an exorenal growth in 45,9%. Resection wasperformed in 30,2%, enucleoresection in 49,7% and enucleation in20,1%.Results: At histopathology, RCC was found in 76,7% and 23,3% werebenign lesions. Cancer free survival was 98,1%. Local tumourrecurrence occurred in 1,3% and metastasis in 0,6%. Intra-operativecomplications were seen in 2 patients (1,2%). In one patient, asplenectomy was necessary for bleeding and in another patient, aradical nephrectomy was done for arterial bleeding.In 15,1%, an early (< 1 month) postoperative complication occurred: apostoperative haematoma was found in 5,7%, acute renal failure in1,9%, wound problems in 1,3% and hematuria and urine leakage in 1patient (0,6%). 5 patients (3,9%) developed pneumonia and 3 patientshad cardiac problems. Late (> 1 month) postoperative complicationsoccurred in 6,3%. Chronic renal failure occurred in 2,5% andwoundherniation in 1,9%. One patient developed an arterial-venousfistula for which a super selective embolisation was performed. Localrecurrence occurred in two patients (1,3%). One patient had arecurrence at the resection site, another patient had a kidneyrecurrence.145