Organ-preserving surgery in renal cell carcinoma--change of the therapeutical concept.

From 1976 to 1989 in 90 patients (n = 98 tumors) with renal cell carcinoma organ-preserving surgery was performed (age 25-84 years, mean 58 years). Imperative indications for organ preservation (tumor removal by partial resection with or without clamping of the artery, autotransplantation) (n = 18) were chronic renal failure, benign pathology of contralateral kidney, functional or anatomical solitary kidney, and bilateral tumors. Elective organ-preserving surgery (n = 72) was done for small peripherally located lesions and in cases of uncertain preoperative tumor dignity. Tumors removed for imperative indications were 2-11 cm (mean 6.5 cm) in size. In the elective group tumor size ranged from 1 to 6 cm (mean 3.5 cm). Follow-up was 3 months to 13 years, 1 postoperative mortality was observed in the group with imperative indication. 15/90 patients are alive without tumor, 1 patient with metastasis, 1 patient died because of metastasis and 1 for unrelated reasons. All patients beside 1 in the group with elective indication are alive without metastasis. Renal cell carcinoma has changed its clinical feature. More and more tumors are detected by ultrasound without clinical symptoms. Though radical tumor nephrectomy still is the standard operation for renal cell cancer, in cases especially with small tumors the indication for organ-preserving operation with regard to these excellent results should be given more often.