Abstract: Objective: To investigate the surgical treatment and prognosis of renal cell carcinoma with a size of 4 cm or less. Methods: A retrospective review of 75 patients who were diagnosed with small renal cell carcinoma of 4 cm or less between January 1992 and December 2002 was conducted to analyze the clinical manifestations, surgical management and survival. Results: Among the 75 patients, 50 (66.7%) cases had tumors that were found accidentally and 25 (33.3%) cases had typical symptoms. All of the 75 patients underwent surgery. Nineteen patients(25.3%) were treated with partial nephrectomy and 56 (74.7%) patients were treated with radical nephrectomy. The median tumor size was 3.2cm (range 1.2-4.0cm). The mean follow-up period was 60 months (range 1-118 months). Overall 5-year survival for patients who underwent partial nephrectomy and radical nephrectomy was 95.4% and 84.7%, respectively. Cancer-specific 5-year survival was 100%. Conclusion: Local renal cell carcinoma with a diameter of 4 cm or less can be treated with either radical or partial nephrectomy with a relatively satisfactory survival.