Radical or simple nephrectomy in localized renal cell carcinoma: what is a choice?

INTRODUCTION: Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies. Surgery remains the only effective method of renal tumors treatment. In fact, for advanced RCC, radical nephrectomy (RN) should remain a standard treatment. However, in localized RCC (LRCC) a real increase of survival rates realized by RN compared with simple nephrectomy (SN) or organ-sparing surgery is discussable. The aim of our study was to assess the impact of nephrectomy type on the prognosis of LRCC treatment. MATERIAL AND METHODS: We analyzed the long-term outcomes of RN (n = 248 pts.) and SN (n = 170 pts.) in 418 pts. with LRCC. There were no significant statistical differences in tumor stages, age stratification or gender between these two groups. To compare the efficacy of RN and SN we determined overall survival (OS) and cancer-specific survival (CSS) rates in both divided groups. The 3-year OS in RN group was 93.1% vs. 91.8% in SN group. RESULTS: CSS rates after the same period were 96.8% vs. 94.7% respectively. The 5-year OS in RN group was 91.5% vs. 88.8% in SN group. After 5 years of follow-up, CSS in RN group was 94.4% vs. 92.4% in SN group. Type of nephrectomy does not influence on LRCC outcomes. The 3- and 5-year overall survival rates and cancer-specific survival rates in RN and SN group were almost identical. CONCLUSION: Hence, if radical nephrectomy does not ensure better survival than simple nephrectomy, the expediency of vast surgery in localized RCC is doubtful.