Local recurrence after tumour enucleation for renal cell carcinoma with no ablation of the tumour bed: results of a prospective single-centre study.

OBJECTIVE • To prospectively evaluate the risk of positive surgical margins and local recurrence after blunt tumour enucleation (TE) with no ablation of the tumour bed. PATIENTS AND METHODS • Between 2005 and 2007, data were gathered prospectively from 201 consecutive patients who had open TE with no ablation of the tumour bed. • Overall, 164 consecutive patients had TE for single sporadic renal cell carcinoma (RCC). • All patients had an abdominal computed tomography (CT) at the last follow-up visit. RESULTS • The pathological review showed that 70.2% of tumours were pT1a, 18.9% were pT1b, 1.8% were pT2 and 9.1% were pT3a. • The mean (range, interquartile range) tumour greatest dimension was 3.5 (0.5-12.5, 2.4-4.1) cm. • Although no deliberate attempt to resect normal parenchyma was performed, the pathological analysis showed the presence of a thin layer of parenchyma with a mean (range) thickness of 0.97 (0.31-1.60) mm, around the tumour. None of the patients had positive surgical margins. • At a mean (median, range) follow up of 40 (38, 25-62) months, three (1.8%) patients had local recurrence, of whom one (0.6%) had a true local recurrence at the enucleation site detected 35 months after surgery, while two had kidney recurrence elsewhere associated with concurrent systemic metastases diagnosed 16 and 13 months after surgery. CONCLUSIONS • TE with no ablation of the tumour bed is a safe technique with a local recurrence rate of 0.6%. • The histopathological analysis showed the presence of a minimal tumour-free surgical margin, although no deliberate attempt to resect normal parenchyma is performed.