Kidney preserving surgery in renal cell tumors: indications, techniques and results in 152 patients.

Between 1975 and 1991, 142 patients with renal cell carcinoma and 10 with oncocytoma underwent a total of 164 kidney preserving operations. The indication for surgery was imperative (group 1, 47 patients) among those with a solitary kidney (9), renal insufficiency (17) or bilateral tumors (21). Of the patients with small or peripheral tumors and a healthy contralateral kidney 105 were selected for elective surgery (group 2). Most procedures were done either without ischemia (24%) or with warm ischemia (69%). In some patients from the imperative indication group hypothermia was achieved by in situ perfusion (5%) or ex vivo work bench surgery and autotransplantation (2%). Complication rates were 15% for group 1 and 9.5% for group 2. In group 1, 3 patients died of cancer, 5 lived with metastases and 2 had local tumor recurrence. No patient in group 2 had recurrences or metastases. The tumor-specific survival rate of patients with kidney preservation for renal cell carcinoma was comparable to that of a control group undergoing radical nephrectomy. Due to the high reliability and efficacy, kidney preserving surgery for renal cell carcinoma should be done more often, even in patients with a normally functioning contralateral kidney.