Is there any limit to nephron sparing surgery for renal tumors in a solitary kidney ? Experience on 37 cases in a single center

Nephron sparing surgery raises the challenge of avoiding chronic hemodialysis for patients having malignancies on a solitary kidney. Patients and method: from 1975 until 2002, 130 enucleations of kidney tumors were performed in our institution among which 100 were cancer. Among those 37 were done on 33 patients with a solitary kidney from which 18 had had a radical controlateral nephrectomy for cancer. Average age was 62 years with a sex ratio of 3.7. Surgery was always conducted through a classical open approach without interruption of blood flow in 92% of cases. Results : Average blood loss was 700 ml. Two patients required transitory post operative dialysis. Three patients died in the post operative period (one from anuria, one from an undiagnosed brain metastasis and one from pulmonary embolism. Pathological findings reported adenocarcinoma in 84% of cases and tubulopapillary tumors in 16%. No reoperation was needed neither for bleeding nor for urinary fistula which occurred in 11% of cases and resolved sponteanously in 75% of cases, the 25% remaining being treated by ureteral drainage. Global survival rate at 5, 10 and 20 years was 69, 56 and 44%. Disease free survival at 5, 10 and 20 years was 56, 27 and 11%. No patient required chronic hemodialysis. Discussion: survival expectancy rate for people beginning hemodialysis between 60 and 64 years old is poor, survival rate at 5 and 10 years being evaluated at 33 and 7%. In our experience, even in the presence of bad prognosis factors as involved lymph nodes or metastasis at the time of diagnosis, high grade tumors, T2 or a past history of radical nephrectomy, results obtained turn out to be better than those of the other alternative which is radical nephrectomy and chronic hemodialysis. Conclusion: taking in account the poor life expectancy of people around 60 being put on hemodialysis, all attempts should be made to perform nephron sparing surgery in patients having a cancer on a solitary kidney.