Mini-Margin Nephron Sparing Surgery for Renal Cell Carcinoma 4 cm or Less

Objectives. To explore the safety and efficacy of mini-margin nephron sparing surgery (NSS) for renal cell carcinoma (RCC) 4 cm or less. Methods. Total of 389 cases of RCC 4 cm or less with normal contralateral kidneys were included in the study, including 135 cases treated by mini-margin NSS, 98 by 1 cm-NSS and 156 by radical nephrectomy (RN). The clinical results were followed-up and comparatively analyzed. Results. The mean and median margin width for mm-NSS was 2.2 and 2.0 mm (range 0 to 5). Of them, 112 (83.0%) cases had margins of 3 mm or less, and 26 had margins of 0 mm (19.3%). The mean width of margin for 1 cm-NSS was 11.6 mm (median 12, range 10~15). None of the NSS patients had positive surgical margins. The mean follow-up for mm-NSS, 1 cm-NSS and RN patients was 69, 82 and 82 months, respectively. Three mm-NSS patients, two 1 cm- NSS and four RN patients died of non-cancer related causes. Two mm-NSS patient (1.6%) experienced local recurrence. No distant metastasis was detected in all the patients. The over all 5-year survivals for NSS and RN patients were 100%, 100% and 98.7%, respectively (P = .950). Conclusions. Mini-margin NSS is as safe and effective as 1 cm-NSS and RN in treating early localized RCC 4 cm or less.