The role of partial nephrectomy for the management of sporadic renal angiomyolipoma

OBJECTIVES Angiomyolipoma is a benign renal tumor that has a propensity to grow over time and may cause local complications. Given the benign nature of these lesions, renal-preserving treatments are favored. We evaluated our experience with nephron-sparing surgery for renal angiomyolipoma. METHODS We reviewed our institutional nephrectomy registry to identify patients treated with nephronsparing surgery for renal angiomyolipoma between 1970 and 2004. Patients with a diagnosis of tuberous sclerosis were excluded. Patient demographics, perioperative complications, and postoperative outcomes were recorded. RESULTS We identified 58 patients treated with nephron-sparing surgery for sporadic renal angiomyolipoma, including 44 women and 14 men; The median tumor size was 3.9 cm (range, 0.8-12.5 cm). In 7 patients (12%), several ipsilateral angiomyolipomas were resected, whereas 2 patients were treated with nephron-sparing surgery for bilateral angiomyolipomas. The overall early complication rate was 12%, including a urine leak in 3 (5%) patients. At a median postoperative follow-up of 8 years (range, 1-31 years), 2 (3.4%) patients had radiographic evidence of local recurrence, although no patient experienced symptom recurrence. The median preoperative serum creatinine level was 1.0 mg/dL (range, 0.5-3.9 mg/dL), and the median creatinine level at last follow-up was 1.1 mg/dL (range, 0.6-3.6 mg/dL). No patient developed de novo chronic renal insufficiency after nephron-sparing surgery, including 4 patients treated for angiomyolipomas in a solitary kidney. CONCLUSIONS Nephron-sparing surgery for sporadic renal angiomyolipomas offers preservation of renal function and is associated with acceptable complication and low local recurrence rates. The results of this study support nephron-sparing surgery for these lesions.