Renal cell cancer: Bench surgery and autotransplantation for complex localised disease

Objective: The strongly increased availability of haemodialysis has limited the number of bench surgeries followed by autotransplantation for complex cases of renal cell carcinoma (RCC) in solitary kidneys during the 1980s and 1990s. However, during recent years, quality-of-life issues, cost aspects, and the relatively high attrition rate under long-term hemodialysis have sparked renewed interest in organ-preserving bench surgery strongly driven by patients' demands. Methods: We reviewed our experience with 36 recent cases of bench surgery and autotransplantation for complex RCC collected prospectively in our database. Results: All tumours were invariably RCCs. In 32 cases a clear-cell type, in 3 cases a papillary type, and in one case a chromophobe type of carcinoma was diagnosed. All cases were considered preoperatively by imaging procedures as "organ-confined," whereas definitive pathology revealed a tumour stage ranging from pT1 to pT3a, always pN0, and M0. Surgical complications were few, but significant: one perioperative death after 5 d due to myocardial infarction, one kidney lost due to transplantation failure, and one patient on hemodialysis for 3 wk until complete functional recovery. Oncologically, after a relatively short follow-up period cif 2.8 yr (median), one patient had distant metastasis and one patient had a recurrent tumour in his kidney after 13 mo. Conclusion: When critically appraising our personal experience consisting of 21 retrospective cases from 1992 to 2000 and of 36 prospective cases (this series) from 2001 to 2006, bench surgery and autotransplantation for complex cases of RC-C are feasible and probably cost effective. There is a clear need for strict inclusion criteria such as an imperative indication and organ-confined (hence, surgically curable disease) stages, a multidisciplinary team approach, suitable infrastructure, and experience in major surgical procedures. If these criteria are met, bench surgery followed by autotransplantation has become again a valuable last resort and is apparently safe. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.