**5. Conclusion**

RCC of > 4 cm. can be treated with elective NSS providing optimal long-term outcome. The surgeon's decision for organ-preserving surgery should depend on the tumor location and

Pahernick S. *et al.* compared the results of NSS for the tumors of less and more than 4 cm. in size. Out of 474 treated patients 102 had the tumor of more than 4 cm. The mean follow-up was 4.7 years. The 5 and 10-year cancer-specific survival for small and large tumors were: 97.9% and 95.8%, 94.9% and 95.8%, respectively. In contrast to the tumor size, stage pT3a was associated with a significantly higher risk of tumor related death. The authors advocat‐ ed that the surgeon's decision with regard to the organ preservation should consider the tu‐ mor location and safe surgical resectability, rather than the tumor size [17]. This conclusion

Joniau S. *et al.* presented their results of NSS for the patients with bigger than 4 cm renal tumors. The following data have been collected and analyzed: surgical indication, tumor characteristics, complications, serum creatinine level, time to recurrence and time to the pa‐ tient death. Local cancer control has been achieved in the vast majority of patients. The renal function was preserved in the patients with elective indications. NSS for absolute indica‐ tions was significantly correlated with the loss of renal function but not with a cancer-specif‐

In our study the local disease recurrence was detected in 2 (3.5%) and the systemic recur‐ rence in 4 (7%) patients. We could not reveal any changes in the serum creatinine level preand postoperatively in the both groups, despite cold ischemia which was used in all patients. Both, the cancer-specific and overall survival was significantly better in the groups of relative and elective indications as compared with the absolute indication (p<0.014 and p<0.023, respectively). These data are similar to the results of the eight-institution multicen‐

It has been shown by Badalato GM. *et al*. in their recent publication that the oncological effi‐ cacy of NSS for pT1b renal tumors was comparable to that of radical nephrectomy [20]. The authors compared the NSS with radical nephrectomy in the patients with T1b RCC using a propensity scoring approach. 11 256 cases of 4-7 cm. tumors that underwent partial or radi‐ cal nephrectomy have been evaluated. The propensity score analysis was used to adjust for the potential differences in the baseline characteristics of the patients between the two groups. Overall and disease-free survival of the patients was compared in stratified and ad‐ justed analysis, controlling for propensity scores. For the entire patient cohort, no difference in the survivals was found in the NSS and radical nephrectomy groups. The survival differ‐ ence between the groups in a propensity-adjusted cohort of patients could not be confirmed

We've observed that the NSS for centrally located tumors was associated with a higher com‐ plication rate. This goes in accordance with the data of Ficarra V. *et al.* who recently pro‐ posed a new tumor scoring system [21]. According to the authors this system can better

technical feasibility rather than on the tumor size [16].

has been later supported by Antonelli A. *et al.* [18].

tre review of 1048 NSS procedures [13].

even when stratified by the tumor size and patient age.

predict the complications after NSS than linear tumor size.

ic survival [19].

92 Renal Tumor

In conclusion, the NSS is a feasible procedure for RCCs of 4-7 cm in size. The local cancer control can be achieved in most patients. Oncological outcome of the treatment is negatively related with the tumor size. Long-term prospective studies on the higher number of patients are required to prove the similar oncological efficacy of NSS and radical nephrectomy in the RCCs of 4-7 cm. in size.
