| Objectives: Over the past years, radical nephrectomy (RN) has been considered as the standard treatment for renal cell carcinoma. Improved imaging modalities have substantially increased the number of incidental, small renal tumours. Consequently a size and stage migration has been observed in renal cell carcinoma (RCC), providing the basis for nephron sparing surgery (NSS) for further. Organ sparing treatment, initially only accepted as standard treatment of RCC in imperative indication (patients with an anatomically or functionally solitary kidney or bilateral synchronous solid renal masses), the indications for the maximal preservation of unaffected renal parenchyma by nephron sparing surgery have been expanded to include patients with small, localized, mostly incidental tumours and a healthy contralateral kidney (elective indication). A large number clinical experience has shown that NSS can not only safe and effective to retain the functional renal units, avoid hemodialysis, and improve the quality of life in patients with less complications, low local recurrence rate and high long-term survival rate. Our study is to report the long-term follow-up of a matched comparison of radical nephrectomy and NSS in patients with single unilateral renal cell carcinoma and a normal contralateral kidney. To further investigate the clinical effects and safety of elective nephron sparing surgery in renal cell carcinoma patients.Methods: Between March 1997 and June 2007, the operation was performed in 250 patients with unilateral early renal cell carcinoma (T1a, tumor diameter≤4cm) and a normal contralateral kidney at the Urology department of First Affiliated Hospital of Dalian Medical University, 150 of these patients had elective indications. All the patients are divided into elective nephron sparing surgery and radical nephrectomy group. Elective nephron-sparing surgery of renal carcinoma was performed in 150 RCC patients. The tumor diameter ranged from 1.1 to 4.0cm with a mean of 3.0cm. Pathological examination showed that 145 cases had clear cell carcinoma;3 had papillary cell carcinoma and 2 had cystic renal carcinoma. The tumor diameter of 100 RN patients ranged from 1.5 to 4.0cm with a mean of 3.4cm. Pathological examination showed that 89 cases had clear cell carcinoma; 6 had papillary cell carcinoma and 3 had chromophobe cell carcinoma. All of them were classified to have T1a stage tumor according to TNM classification. The patients had unilateral tumor. The contralateral kidney functioned were well. The 2 groups were matched according to pathological grade, pathological T stage, size of tumor, age, sex, operative time, blood loss during operation and year of surgery. After operation all the patients followed by questionnaire underwent abdominal CT, ultrasound, urine test and renal function examination regularly. Cancer-specific survival was estimated using the Kaplan-Meier method.Results: The operation was performed successfully in all the 150 patients. There was no significant difference between the two groups with age, tumor diameter, pathological classification, operative time, blood loss during operation and follow-up time. After a mean follow up of 61 months 3 of 150 patients treated with NSS had died, none of them tumour related. Tumour recurrence was detected in 1 patients (0.67%). Others were free of tumour at last follow-up. The RN group, after a mean follow up of 62 months, 4 patients died of cardiocerebral vascular diseases. Cancer survival rates at 5 and 10 years for patients treated with NSS (RN) were no difference. Conclusions: NSS is as effective as RN for the treatment of localized RCC on long-term follow-up and NSS can safe and effective to retain the functional renal units with less local recurrence rate. It is selective for RCC patients with localized unilateral tumor and a normal contralateral kidney.
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