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Objective: The RENAL nephrometry scoring system charac-terizes tumors according to their size, growth pattern, loca-tion and nearness to the renal sinus or collecting system. The current study alms to evaluate the RENAL nephrometry scor-ing system in adopting nephron-sparing surgery (NSS) for cTI renal cancer. Methods: Clinicopathological data of 200 con-secutive patients who had undergone radical nephrectomy (RN) or NSS for clinical stage T1 renal cell cancer at our single institution during 2005-2009 were investigated retrospec-tively. Results: Of 200 patients, 103 were scheduled for RN, whereas 97 were planned to undergo NSS, 9 of whom actu-ally underwent RN. Those who were planned to undergo NSS were youngerand had smaller tumors (p<0.001).The median RENAL score was significantly lower among those who were originally assigned to NSS (5, range 4-10) versus RN (8, range 4-11) (p < 0.001). Three months after surgery, the renal func-tion of patients who had been scheduled for NSS was signifi-cantly better than in those treated by RN (p < 0.001). Conclu-sions: This study suggests that the RENAL nephrometry scor-ing system is a useful tool in adopting NSS for cTI renal cancer and that objective decision-making for NSS was possible. [ABSTRACT FROM AUTHOR]