[Conservative surgery in the treatment of tumors of the renal parenchyma. 10 years' experience and results].

BACKGROUND: Radical surgery is considered standard treatment of renal tumours confined to the organ without detectable multiple metastases. In some circumstances, however, imperative or elective conservative surgery is indicated. The objective of the present work was, based on the authors' experience, to define more accurately indications for conservative surgery and evaluate the rate of local relapses of tumours and the patients' survival. METHODS AND RESULTS: The method of conservative surgery was used in 58 patients (34 men, 24 women, mean age 26-76 years, range 56 years). The indications for surgery were as follows: bilateral tumour (11x), tumour in solitary kidney (4x), tumour in kidney of abnormal shape (2x), and tumour defined by a capsule growing extrarenally reaching a size up to 3 cm (39x). In small tumours, less than 3 cm, 29x enucleation was performed and 10 times resection of the kidney. In patients with a bilateral tumour, with a tumour in a solitary kidney in kidneys with an abnormal shape or functionally impaired kidneys 15x resection and 4x enucleation of the tumour was performed. On histological examination 20% of the tumours were classified as benign. One to five-year survival after operation was evaluated in patients with histologically confirmed malignant tumours. On comparison with five-year survival of patients with a malignant tumour after radical nephrectomy (patients of the authors), it was revealed that after conservative surgery 85% patients survived, while after a radical operation only 57%. This difference is according to the authors due among others to a low biological activity of small tumours, their low staging and grading. CONCLUSIONS: An imperative or elective conservative operation is beneficial in particular in patients with a small tumour and low grading. This is suggested by the higher percentage of patients surviving five years after operation without evidence of a local relapse of the tumour.