PTU - Polskie Towarzystwo Urologiczne
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Ex situ study of the effectiveness of enucleation in patients with renal cell carcinoma as a nephron sparing procedure
Article published in Urologia Polska 2003/56/4.


Cezary Szcześniak 1, Piotr Chłosta 2, Tomasz Dzik 3, Andrzej Borówka 1
1 Klinika Urologii, I Zespół Dydaktyki Urologicznej CMKP, Oddział Urologii Centralnego Szpitala Kolejowego w Warszawie
Kierownik kliniki, ordynator oddziału: prof. dr hab. Andrzej Borówka
2 EuroMediCare Oddział Urologii Szpitala Specjalistycznego we W


kidney, renal cell carcinoma, nephron sparing surgery, enucleation of tumor


The efficacy of radical nephrectomy for cure of localized renal cell carcinoma (RCC) is well established. However, more and more often, nephron sparing surgery (NSS) is a treatement option not only for the patient with bilateral RCC or a solitary kidney but also as a elective procedure for selected unilateral tumors in patients with normal contralateral kidney. There are two kinds of NSS: partial nephrectomy and enucleation.
Evaluation of the risk of residue tumor cells in the tumor bed after ex vivo enucleation.
material and methods
In an effort identify the efficacy of enucleation in the treatment of RCC, surgical specimens from 70 patients undergoing radical nephrectomy (RN) or partial nephrectomy as the only type of NSS, were studied after ex vivo enucleation. Patients with tumors under or equivocal 4 cm in diameter, were undergoing NSS and others (tumors over 4 cm) RN. Each tumor was enucleated ex vivo after planned procedure. Specimens were studied pathologically with special regarding to residual tumor in the bed.
The risk of unsuccessfull enucleation among tumors over 4 cm in diameter (RN group) is 36.8%, and among tumors under and equivocal 4 cm (NSS group) is 7.4%. Most successfully enucleated tumors (risk = 0%) had under 21 mm in diameter.
The results of the study suggest, that the risk of enucleation is too large to treat this procedure as a safe treatment option. In imperative cases, enucleation is possible option in cases of tumors under 21 mm in diameter.