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 chronichemodialysis for patients having malignancies on a solitary kidney.Patients and method: from 1975 until 2002, 130 enucleations ofkidney tumors were performed in our institution among which 100were cancer. Among those 37 were done on 33 patients with a solitarykidney from which 18 had had a radical controlateral nephrectomyfor cancer. Average age was 62 years with a sex ratio of 3.7.Surgery was always conducted through a classical open approachwithout interruption of blood flow in 92% of cases.Results : Average blood loss was 700 ml. Two patients requiredtransitory post operative dialysis. Three patients died in the postoperative period (one from anuria, one from an undiagnosed brainmetastasis and one from pulmonary embolism. Pathological findingsreported adenocarcinoma in 84% of cases and tubulopapillarytumors in 16%. No reoperation was needed neither for bleeding norfor urinary fistula which occurred in 11% of cases and resolvedsponteanously in 75% of cases, the 25% remaining being treated byureteral 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, 27and 11%. No patient required chronic hemodialysis.Discussion: survival expectancy rate for people beginning hemodialysisbetween 60 and 64 years old is poor, survival rate at 5 and 10years being evaluated at 33 and 7%. In our experience, even in thepresence of bad prognosis factors as involved lymph nodes or metastasisat the time of diagnosis, high grade tumors, T2 or a pasthistory of radical nephrectomy, results obtained turn out to be betterthan those of the other alternative which is radical nephrectomy andchronic hemodialysis.Conclusion: taking in account the poor life expectancy of peoplearound 60 being put on hemodialysis, all attempts should be madeto perform nephron sparing surgery in patients having a cancer on asolitary kidney.