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October 13, 2004

Nephron-Sparing Surgery and Renal Cell Carcinoma

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(14):1684. doi:10.1001/jama.292.14.1684-a

To the Editor: The review of renal cell carcinoma by Dr Curti1 did not discuss nephron-sparing surgery (NSS) as an alternative to radical or laparoscopic nephrectomy. The risk of recurrence with NSS in appropriately sized tumors is less than 5%, which is equivalent to nephrectomy.2,3 The risk of complications from NSS likewise is comparable with nephrectomy.2,3 The benefit to the patient in terms of both preservation of renal function2 and positive effect on patient quality of life4 has been well documented over the last decade. Indeed, NSS has been discussed as a possible standard of care for tumors less than 4 cm in diameter,5 and for appropriately selected patients this may be extended up to 7 cm in diameter.3 Given the evidence in favor of NSS for renal tumors less than 4 cm in size, a complete discussion of the current management of renal cell carcinoma should include NSS as a therapeutic option.

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