The evolving role of partial nephrectomy in the management of renal cell carcinoma

Abstract

The surgical management of renal cell carcinoma has undergone critical review over the past decade. Initially treated with radical nephrectomy, renal cell carcinoma is now approached with nephron-sparing surgical techniques. Improved imaging modalities have substantially increased the number of incidental renal tumors detected, and with the increasing number of incidentally detected kidney tumors, a size and stage migration has occurred in renal cell carcinoma. Early studies showed that disease-free survival rates were similar between cancers treated with radical and partial nephrectomy. The standard now is to offer partial nephrectomy as a surgical option to all patients with renal lesions measuring 4.0 cm or smaller in the setting of a normal contralateral kidney. More recent issues regarding partial nephrectomy concern complication rates and management, renal cell carcinoma multifocality, margin status and distance to normal renal parenchyma, cost analysis, and the development of laparoscopic techniques that duplicate open partial nephrectomy. The purpose of this review is to outline and analyze these more recent concerns regarding partial nephrectomy.

Controlled Survival Study of the Effects of Tisseel or a Combination of FloSeal and Tisseel on Major Vascular Injury and Major Collecting-System Injury during Partial Nephrectomy in a Porcine Model

“…As the favorable oncologic results began to surface, however, the next decade witnessed a broadening of the indications for nephron-sparing surgery. [4][5][6][7] Although the complication rates are slightly higher than those of open radical nephrectomy, the advantages in terms of renal preservation have become more apparent. As a result, partial nephrectomy being performed more frequently, even in patients with a normal contralateral kidney.…”

Laparoscopic radical nephrectomy: current status

“…Increased awareness of the biological potential of various renal tumours and of the long-term benefits of nephron-sparing surgery have increased the use of elective partial nephrectomy [35]. As a result, LRN for the small-to-moderate tumour has gradually, and appropriately, decreased in frequency, and urologists must avoid using LRN simply because it can be done.…”

Laparoscopic partial nephrectomy: Technique, oncologic efficacy, and safety

“…NSS now is applied to patients with a compromised contralateral kidney or conditions that may impact future renal function such as diabetes mellitus or hypertension (relative indication) and those with small tumors (< 4 cm), even in the presence of a normal contralateral kidney (elective indication) [14,15]. Masses larger than 4 cm usually are not considered for elective NSS because of concern about multifocality and increasing risk of ipsilateral recurrence in association with larger tumors, although some investigators are pushing the size limit for elective NSS up to 7 cm.…”