Objectives: The aim of the study is to evaluate the impact of nephron–sparing surgery on postoperative quality of life (QOL) in patients with localized renal cell carcinoma, compared with radical nephrectomy. Methods: From 1986 to 1996, a total of 66 patients with localized small renal cell carcinoma Results: There is no significant difference in 5–year overall survival between the nephron–sparing surgery group and the radical nephrectomy group. With regard to postoperative QOL, patients who underwent nephron–sparing surgery showed a significantly higher score on physical function than patients treated with radical nephrectomy (pConclusion: Selected patients with localized, small, unilateral renal cell carcinoma and a normal contralateral kidney will benefit from nephron–sparing surgery.