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Renal Cancer pp 159-184 | Cite as

Rationale for Partial Nephrectomy, Current Practice Patterns

  • Nicholas M. Donin
  • William C. Huang
Chapter

Abstract

The incidence of renal cortical tumors (RCTs) has progressively risen over the last 30 years, believed to be largely attributable to the increasing use of abdominal imaging for unrelated conditions. Currently over two-thirds of newly diagnosed renal masses are <4 cm, so-called small renal masses (SRMs). Because there is no curative medical therapy, and because the natural history of these masses is not well understood, the primary treatment of SRMs has historically been prompt surgical excision. While curative extirpative surgery was traditionally accomplished by radical nephrectomy (RN), advances in surgical technique, as well as the recognition of the potentially deleterious renal functional and cardiovascular effects that may occur following surgically induced nephron loss prompted an interest in utilizing nephron-sparing techniques, particularly partial nephrectomy (PN). Prospective and retrospective studies have demonstrated that PN carries a lower risk of long-term renal dysfunction, and have demonstrated oncologic outcomes equivalent to RN. As such, elective PN is considered the preferred treatment for patients requiring intervention for cT1a and select cT1b renal masses. There is, however, some disagreement between prospective and retrospective data with regard to the overall survival benefits conferred by partial nephrectomy, leading some to question whether the increased mortality rates and cardiovascular disease attributable to decreased renal function from systemic and intrinsic renal diseases is truly applicable to decreased renal function purely from the surgical loss of nephrons. These considerations have led some to suggest that the pendulum in favor of PN “at all costs” may have swung too far and are reflected in the most recent AUA Guidelines for the Renal Masses and Localized Renal Cancer.

Keywords

Renal cortical tumors Small renal masses Radical nephrectomy Partial nephrectomy Active surveillance Nephron-sparing surgery Chronic kidney disease Modification of diet in renal disease Cardiovascular disease 

Abbreviations

AS

Active surveillance

ASCO

American Society for Clinical Oncology

AUA

American Urological Association

CKD

Chronic kidney disease

EAU

European Association of Urology

EORTC-GU

European Organization for Research and Treatment of Cancer Genito-Urinary Group

ESRD

End-stage renal disease

LPN

Laparoscopic partial nephrectomy

LRN

Laparoscopic radical nephrectomy

MDRD

Modification of Diet in Renal Disease

MSKCC

Memorial Sloan-Kettering Cancer Center

NCCN

National Comprehensive Cancer Network

NSS

Nephron-sparing surgery

OPN

Open partial nephrectomy

ORN

Open radical nephrectomy

PN

Partial nephrectomy

QOL

Quality of life

RCTs

Renal cortical tumors

RMS

Renal mass sampling (RMS)

RN

Radical nephrectomy

RPN

Robotic partial nephrectomy

SEER

Surveillance epidemiology and end results

SRMs

Small renal masses

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Nicholas M. Donin
    • 1
  • William C. Huang
    • 2
  1. 1.Department of Urology, Division of Urologic OncologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of Urology, Division of Urologic OncologyNYU Langone Medical CenterNew YorkUSA

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