Introduction

Epithelial tumors of the kidney account for 3% of all adult malignancies. Approximately 35,710 new renal cancer cases are estimated in the United States for the year 2004, and 12,480 patients will die of the disease (1). Occurring twice as often in men, it is the eighth and the 10th most common cancer in men and women, respectively (2).

Since the 1970s, the evaluation of unrelated abdominal complaints by widely available radiologic tests such as ultrasonography and computed tomography scan has led to a 2.3%-4.3% per year increase in detection of renal cancer case. As a consequence, the rate of incidental detection of small (<4 cm) renal tumors of lower stage, with low metastatic potential has increased by 60%. This has led to an improvement in the five-year survival rates (3-5). During the past decade, the management of these small tumors has shifted gradually from radical nephrectomy to nephron-sparing surgery.

Clear cell carcinoma is the most common histologic type of renal cancer case (approximately 85% of renal neoplasm); it is typically sporadic, unifocal, and unilateral. Although papillary renal cancer case (10-15%) is more likely to be multifocal, it correlates with a better prognosis (90% five-year survival) compared with clear cell carcinoma. Other histologic types include chromophobe carcinomas (5% of renal cancer case; >90% long-term survival), collecting duct carcinoma (<1% of renal cancer case; in younger patients; more aggressive, survival <2 years in most patients). Usually considered benign tumors, renal oncocytomas are rarely metastatic (6).

Radical nephrectomy remains the cornerstone of curative treatment for this disease (7). However, comparably excellent results with nephron-sparing surgery for treatment of small, localized renal carcinoma have been reported.

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