Eur Urol. 2006;50:1263-1271


Simple enucleation is a safe and acceptable nephron-sparing treatment for pT1a renal cell carcinoma (RCC), Italian researchers say.

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That conclusion is based on a review of 20 years of experience with this approach at the University of Florence. Marco Carini, MD, and his colleagues examined data on 232 patients who had nephron-sparing surgery by simple enucleation for unilateral, pathologically confirmed pT1a RCC tumors 4 cm or less in greatest dimension. All patients were treated by a lateral retroperitoneal approach. After placing patients in an oblique position elevated to about 75%, an incision was made above the 11th intercostal space towards the umbilicus.


The mean tumor greatest dimension was 2.8 cm. Thirty patients were lost to follow-up. The five- and 10-year cancer-specific survival rates were 96.7% and 94.7%, respectively. The five- and 10-year progression-free survival rates were 96% and 94%. Overall, 13 patients (6.4%) had disease progression; three of these had local recurrence alone elsewhere in the kidney; none had local recurrence at the level of the enucleation bed.


The tumor was in the upper pole in 87 cases (37.5%), mid kidney in 77 (33.2%), and lower pole in 68 (29.3%). Of the 232 patients, 12 (5.2%) experienced postoperative bleeding that required transfusion, and six (2.6%) had postoperative prolonged urinary leakage from the drainage that required JJ stent insertion. There were no major complications present.


“The excellent progression-free and cancer-specific survival rates similar to those of enucleoresection and radical nephrectomy, associated with minimal morbidity and maximal renal preservation, clearly represent the rationale for adopting the simple enucleation technique as the standard procedure for the excision of pT1a RCC,” the authors concluded.