Warm Ischemia or Cold Ischemia During Surgery in Treating Patients With Stage I Kidney Cancer

OBJECTIVES:

Primary

• Determine the effect of warm ischemia during partial nephrectomy on long-term renal function in patients with solitary stage I renal cortical tumor and normal contralateral kidney.

Secondary

• Determine to what degree the contralateral kidney compensates for the damage inflicted on the operated kidney during surgery.
• Determine the 1-year disease-specific and overall survival of these patients.

OUTLINE: This is a multicenter study. Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients undergo warm ischemia followed by partial nephrectomy.
• Arm II: Patients undergo cold ischemia followed by partial nephrectomy. Blood and urine samples are collected periodically after nephrectomy to assess renal function.

Patients are followed at 1, 3, 6, 9 , and 12 months after nephrectomy.

DISEASE CHARACTERISTICS:

• Diagnosis of solitary renal cortical tumor

• Tumor size ≤ 4 cm
• Candidate for open partial nephrectomy

• Expected ischemia time < 45 minutes
• Normal renal function, defined as glomerular filtration rate (GFR) > 60 mL/min
• No evidence of distant metastasis
• No evidence of local invasion of adjacent structures, including the adrenal gland
• No evidence of tumor extension into the renal venous system
• No evidence of ureteral obstruction on MAG-3 renal scan
• No family history of renal cancer

PATIENT CHARACTERISTICS:

• ECOG performance status 0
• Life expectancy > 5 years
• No prior malignancy, except for non-melanomatous skin cancer

PRIOR CONCURRENT THERAPY:

• Not specified