Between 1969Between und 1989
conservative surgery for kidney tumors was performed in 123 patients. In 49 patients there was an imperative indication for a parenchyma-sparing operation because nephrectomy would have made dialysis obligatory. Thirty-five of these 49 patients show no signs of tumor progression after a mean follow-up of 4.5 years. Known metastases were present in 3 of 6 patients who died as a result of their tumors. In two patients there was a recurrence after 1 and 5 years, respectively, requiring a second organ-preserving operation. In one further patient we suspect that multiple small tumor lesions may be present 2 years after the first operation. In 74 patients with a healthy contralateral kidney the tumor was enucleated by choice (elective indication). Sixty-eight of these 74 patients show no signs of tumor progression after a mean follow-up period of 3.3 years. One patient died from tumor metastases. Two patients had tumor recurrence, requiring nephrectomy and enucleation, respectively. Fifty-seven enucleated tumors were available for image analysis DNA cytometry. Only the two patients with a hypertriploid tumor died from their cancer.
Until now radical nephrectomy has been regarded as standard therapy for non-metastasized renal cell carcinoma [15,18,21]. This operation has been accepted because of its theorized advantage of more complete resection. A parenchyma-sparing operation has only been performed on patients in whom radical nephrectomy would result in renal failure requiring hemodialysis (imperative indication), such as those with a single kidney, bilateral tumors, dysfunctional contralateral kidney or chronic renal failure. However, the widely used partial nephrectomy in these instances may result, in certain cases, in insufficient residual renal parenchyma [14]. Simple enucleation of the tumor, together with a small surrounding margin of normal renal tissue, is an alternative technique to this