Kidney Cancer Simple Enucleation for the Treatment of PT1a Renal Cell Carcinoma: Our 20-Year Experience Marco Carini *, Andrea Minervini, Lorenzo Masieri, Alberto Lapini, Sergio Serni Department of Urology, University of Florence, Careggi Hospital, Florence, Italy european urology 50 (2006) 1263–1271 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted May 15, 2006 Published online ahead of print on June 6, 2006 Keywords: Enucleation Local recurrence Nephron-sparing surgery Partial nephrectomy RCC Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. Abstract Objectives: To evaluate the safety and efficacy of simple enucleation as a conservative treatment for pT1a RCC, and to report on the incidence of major complications, local recurrence, and progression-free and disease-specific survival rates. Methods: We retrospectively reviewed the data of 232 patients who had nephron-sparing surgery (NSS) by simple enucleation between 1986 and 2004 for sporadic, unilateral, pathologically confirmed pT1a RCC. The patients’ status was evaluated last in September 2005. The mean (med- ian, range) follow-up was 76 (61, 12–225) months. Results: The mean (SD, median, range) tumor greatest dimension was 2.8 (0.78, 2.85, 0.6–4) cm. The histopathologic review according to the Inter- national Union Against Cancer and American Joint Commission for Cancer (1997) classification revealed 198 clear cell (85.3%), 18 papillary (7.8%), 15 chromophobe (6.5%) and one (0.4%) collecting duct RCCs. There were no major complications, such as prolonged acute tubular necrosis/ chronic renal insufficiency and bleeding requiring open reoperation. One patient developed postoperative late retroperitoneal fluid collection consistent with urinoma, which required aspiration, drainage position and JJ stenting for 3 weeks. The 5- and 10-year cancer-specific survival were 96.7% and 94.7%, respectively. The 5- and 10-year progression-free survival were 96% and 94%, respectively. Overall, 13 (6.4%) patients had disease progression, three of whom had local recurrences alone (1.5%) elsewhere in the kidney; none had local recurrence at the level of the enucleation bed. Conclusions: Simple tumor enucleation is a safe and acceptable nephron- sparing treatment that provides excellent long-term local control and cancer-specific survival rates. # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Clinica Urologica I, Azienda Ospedaliera Careggi, Universita ` di Firenze, Villa Monna Tessa, Viale Pieraccini 18, 50139, Firenze, Italia. Tel. +39 055 417645; Fax: +39 055 4377755. E-mail address: carini@unifi.it (M. Carini). 0302-2838/$ – see back matter # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2006.05.022