Results of radical nephrectomy for peripheral well-circumscribed renal cell carcinoma.

Recently, several authorities have argued that, whenever surgically feasible, parenchyma-conserving surgery rather than radical nephrectomy should be the preferred treatment for renal cell carcinoma. They affirm that the results reported following partial nephrectomy are as good as those reported following radical nephrectomy for renal cell carcinoma. However, parenchyma-conserving surgery is usually performed only for relatively small, well-circumscribed tumors that do not involve the collecting system extensively or the renal hilum. To determine the results when radical nephrectomy is used to manage similar tumors, we reviewed the clinical records and arteriograms of 111 patients with renal cell carcinoma. Review of the arteriograms showed that parenchyma-conserving surgery could have been performed in 10 cases (9%). The disease-free survival rate for these 10 patients after radical nephrectomy was 100 percent, and they had no local recurrences. On the basis of these data, we believe that radical nephrectomy remains the best treatment for all patients who have renal cell carcinoma and a normal contralateral kidney.