Abstract: Objective To evaluate the clinical effects of nephron-sparing surgery in patients with early-stage small renal cell carcinoma.Methods Nephron-sparing surgery was performed in 21 patients with renal cell carcinoma including 1 with solitary kidney, 3 with unilateral tumor and contralateral renal compromise, and 17 with unilateral tumor and normal contralateral kidney. The diameter of the tumors ranged from 1.5 to 6.0cm, with a mean of 2.8cm. The tumor diameter in 17 patients with normal contralateral kidney was less than 4cm (mean 2.5 cm) and the average diameter in 4 patients with contralateral renal compromise was 4.2 cm. Sixteen cases were in stage T₁,4 in stage T₂, and 1 in stage T₃. Of the 21 patients, 4 underwent tumor enucleation, 10 polar nephrectomy and 7 wedge resection.Results All patients were followed up for an average of 40.8 months (7 to 66 months). One patient suffered a right lung and mediastinum metastasis 3 years after the surgery later and 1 with chronic glomerulonephritis required dialysis 27 months after the operation. No surgical complication or local recurrence were found in other patients.Conclusion As a safe and effective therapy for early-stage small renal cell carcinoma, nephron-sparing surgery can be considered as the gold-standard therapy for patients with lesions less than 4cm in T₁ and T₂ stages of localized unilateral tumor with normal contralateral kidney.