Objective: To assess safety and effectiveness of excision of small renal cancer.
Methods: We reviewed the records of 94 patients, who underwent, from 1992 to 2001, excision of renal tumor leaving around it a thin layer of grossly normal parenchyma and adjacent perinephric fat. This technique has been called enucleoresection, as it is not a simple enucleation but neither a conventional partial nephrectomy. Patients were followed up mean routine blood examination, ultrasound and computed tomography scan every 6 months for 2 years and annually thereafter.
Results: Median age was 63 years (35-76). Median tumour size was 2.1cm (1.1-4.5). Clamping of renal pedicle was performed in 54 cases. Major complications included 4 cases of haemorrhage; only 1 patient required surgical exploration. Pathological stage was pT1a in 87, pT1b in 4 and pT3a in 3 patients. Surgical margins were always negative. Median follow-up was 59 months (range 10-128). Eight patients died without evidence of tumour recurrence. One pT3a patient developed distant metastases and died 2 years after surgery. Five years survival rate was 95.7% (90/94 patients), cancer specific survival rate 98.9% (93/94) and disease free survival rate 98.9% (93/94).
Conclusions: Enucleoresection of small renal tumors surrounded by a minimal layer of grossly normal renal parenchyma reproduces the results of partial and radical nephrectomy with minimal morbidity.