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Efficacy of Nephron sparing surgery for renal cell carcinomaDepartment of surgery,Medical school of Zhejiang universitypostgraduate: Yu Jiandi supervisor: Zhang ZhigenDuring recent years the use of the new imaging techniques, ultrasonography and computerized tomography,has increased.The accessibility to these methods has changed the pattern of detection of renal lesions. Over 90% of renal masses are now discovered incidentally,while investigating nonurological symptoms.Therefore,most lesions are discovered in there early stages.The gold-standard procedure for removing renal masses is radical nephrectomy,which ensures complete removal of an organ-confined lesion,but involves loss of functional tissue .Nephron sparing surgery was developed in order to preserve as much functional tissue as possible while removing safely any suspicious renal lesion. Although the performance of nephron-sparing surgery in patients with a-4-2003 ^normally functioning contralateral kidney is controversial, nephron-sparing surgery is increasingly being used to treat patients with solid renal lesions. The technical success rate of nephron sparing surgery is excellent,and operative morbidity and mortality are low.For renal cell carcinoma long-term cancer-free survival is comparable to that after radical nephrectomy., particularly for early stage disease.OBJECTIVE: To evaluate the role of nephron sparing surgery in patients with renal cell carcinoma, and the feasibility of improved surgical enucleation as the method of nephron sparing surgery.METHODS: First we retrospectively analyzed a total of 17 patients who had undergone nephron sparing surgery for renal cell carcinoma between Sep 1997 and Sep 2002,among these patients ,2 cases were bilateral asynchronous and multicentric tumor,! 5 cases were unifocal tumor .2cases with imperative indications,6 cases with relative indications,and 9 cases with elective indications.The tumor’s diameter ranged from 2 cm to 6cm,all tumor staged in T1(1997TNM staging system). 15cases underwent improved turner enucleation with a surgical margin of-5-lifi 2003 i?ffi?1cm,lease underwent upper polar nephrectomy,lease underwent wedge resection. We also seleced 20 patients matched for age , tumor location and stage who underwent radical nephrectomy at same period for comprasion with an average follow-up of 36.45 months.And secondly we seleced radical nephrectomy specimens of 21 localized unilateral renal carcinoma patients(Tl), performed surgical enucleation ex vivo and carefully investigated the surgical margin of 0.3,0.5cm and the para-vessels(renal) lymph nodes pathologically .RESULTS: The patients were followed up for an average period of 35.2 months (range 3 to 63 months),no surgical complication or local tumor reccurrence has been observed, its long-term cancer-free survival rate is comparable to that after radical nephrectom.And no tumor invasion or mutifocal lesions found in all of 21 radical nephrectomy specimens under pathological investigation.CONCLUSIONS: Nephron sparing surgery(improved surgical enucleation or partial nephrectomy) is safe and effective for the treatment of renal cell carcinoma and indicated for patients-6-2003with small,localized,often incidental tumors and a normal contralateral kidney.