Renal Cancer pp 159-184 | Cite as

Rationale for Partial Nephrectomy, Current Practice Patterns

  • Nicholas M. Donin
  • William C. Huang


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.


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 



Active surveillance


American Society for Clinical Oncology


American Urological Association


Chronic kidney disease


European Association of Urology


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


End-stage renal disease


Laparoscopic partial nephrectomy


Laparoscopic radical nephrectomy


Modification of Diet in Renal Disease


Memorial Sloan-Kettering Cancer Center


National Comprehensive Cancer Network


Nephron-sparing surgery


Open partial nephrectomy


Open radical nephrectomy


Partial nephrectomy


Quality of life


Renal cortical tumors


Renal mass sampling (RMS)


Radical nephrectomy


Robotic partial nephrectomy


Surveillance epidemiology and end results


Small renal masses


  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.CrossRefGoogle Scholar
  2. 2.
    Simard EP, Ward EM, Siegel R, Jemal A. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J Clin. 2012;62(2):118–28.CrossRefPubMedGoogle Scholar
  3. 3.
    Chow W-H, Devesa SS, Warren JL, Joseph F, Fraumeni J. Rising incidence of renal cell cancer in the United States. JAMA. 1999;281(17):1628–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Decastro GJ, McKiernan JM. Epidemiology, clinical staging, and presentation of renal cell carcinoma. Urol Clin North Am. 2008;35(4):581–92; vi.CrossRefPubMedGoogle Scholar
  5. 5.
    Hock LM, Lynch J, Balaji KC. Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol. 2002;167(1):57–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Gandaglia G, Ravi P, Abdollah F, Abd-El-Barr A-E-RM, Becker A, Popa I, et al. Contemporary incidence and mortality rates of kidney cancer in the United States. Can Urol Assoc J. 2014;8(7–8):247–52.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR. Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer. 2008;113(1):78–83.CrossRefGoogle Scholar
  8. 8.
    Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006;98(18):1331–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Wei JT. National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology. 2006;67(2):254–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Mindrup SR, Pierre JS, Dahmoush L, Konety BR. The prevalence of renal cell carcinoma diagnosed at autopsy. BJU Int. 2005;95(1):31–3.CrossRefPubMedGoogle Scholar
  11. 11.
    Surveillance Epidemiology and End Results Program. Accessed at
  12. 12.
    Linehan WM. The genetic basis of kidney cancer: implications for management and use of targeted therapeutic approaches. Eur Urol. 2012;61(5):896–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Deng F-M, Melamed J. Histologic variants of renal cell carcinoma: does tumor type influence outcome? Urol Clin North Am. 2012;39(2):119–32, v.CrossRefPubMedGoogle Scholar
  14. 14.
    Schmidbauer J, Remzi M, Memarsadeghi M, Haitel A, Klingler HC, Katzenbeisser D, et al. Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses. Eur Urol. 2008;53(5):1003–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Barwari K, de la Rosette JJ, Laguna MP. The penetration of renal mass biopsy in daily practice: a survey among urologists. J Endourol. 2012;26(6):737–47.CrossRefPubMedGoogle Scholar
  16. 16.
    Uzzo R, Russo P, Chen D, et al. Multicenter phase 3 REDECT trial with iodine I 124 Girentuximab-PET/CT for the presurgical detection of clear cell renal cell carcinoma (ccRCC) [abstract]. Kidney Cancer J. 2010;8:79, 85.Google Scholar
  17. 17.
    Rowe SP, Gorin MA, Hammers HJ, Javadi MS, Hawasli H, Szabo Z, et al. Imaging of metastatic clear cell renal cell carcinoma with PSMA-targeted 18F-DCFPyL PET/CT. Ann Nucl Med. 2015;29(10):877–82.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kutikov A, Fossett LK, Ramchandani P, Tomaszewski JE, Siegelman ES, Banner MP, et al. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology. 2006;68(4):737–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003;170(6 Pt 1):2217–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Fujii Y, Komai Y, Saito K, Iimura Y, Yonese J, Kawakami S, et al. Incidence of benign pathologic lesions at partial nephrectomy for presumed RCC renal masses: Japanese dual-center experience with 176 consecutive patients. Urology. 2008;72(3):598–602.CrossRefPubMedGoogle Scholar
  21. 21.
    Herr H. Surgical management of renal tumors: a historical perspective. Urol Clin North Am. 2008;35:543–9; v.CrossRefPubMedGoogle Scholar
  22. 22.
    Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969;101(3):297–301.CrossRefGoogle Scholar
  23. 23.
    Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991;146(2):278–82.CrossRefPubMedGoogle Scholar
  24. 24.
    Goldstein AE, Abeshouse BS. Partial resections of the kidney. J Urol. 1937;38(1):15–42.CrossRefGoogle Scholar
  25. 25.
    Vermooten V. Indications for conservative surgery in certain renal tumors: a study based on the growth pattern of the cell carcinoma. J Urol. 1950;64(2):200–8. PubMed – NCBI [Internet]. [cited 2018 Jun 16]. Available from: Scholar
  26. 26.
    Simmons MN, Gill IS. Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system. J Urol. 2007;177(6):2067–73; discussion 2073.CrossRefPubMedGoogle Scholar
  27. 27.
    Stephenson AJ, Hakimi AA, Snyder ME, Russo P. Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol. 2004;171(1):130–4.CrossRefPubMedGoogle Scholar
  28. 28.
    Sutherland SE, Resnick MI, Maclennan GT, Goldman HB. Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol. 2002;167(1):61–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Timsit M-O, Bazin J-P, Thiounn N, Fontaine E, Chrétien Y, Dufour B, et al. Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology. 2006;67(5):923–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P. Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol. 2000;163(3):730–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000;75(12):1236–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Crépel M, Jeldres C, Sun M, Lughezzani G, Isbarn H, Alasker A, et al. A population-based comparison of cancer-control rates between radical and partial nephrectomy for T1A renal cell carcinoma. Urology. 2010;76(4):883–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Thompson RH, Siddiqui S, Lohse CM, Leibovich BC, Russo P, Blute ML. Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol. 2009;182(6):2601–6.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Leibovich BC, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004;171(3):1066–70.CrossRefPubMedGoogle Scholar
  35. 35.
    Dash A, Vickers AJ, Schachter LR, Bach AM, Snyder ME, Russo P. Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm. BJU Int. 2006;97(5):939–45.CrossRefPubMedGoogle Scholar
  36. 36.
    Patard J-J, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171(6 Pt 1):2181–5, quiz 2435.CrossRefPubMedGoogle Scholar
  37. 37.
    Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59(4):543–52.CrossRefPubMedGoogle Scholar
  38. 38.
    Yossepowitch O, Thompson RH, Leibovich BC, Eggener SE, Pettus JA, Kwon ED, et al. Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. J Urol. 2008;179(6):2158–63.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Breda A, Stepanian SV, Liao J, Lam JS, Guazzoni G, Stifelman M, et al. Positive margins in laparoscopic partial nephrectomy in 855 cases: a multi-institutional survey from the United States and Europe. J Urol. 2007;178(1):47–50; discussion 50.CrossRefPubMedGoogle Scholar
  40. 40.
    Bensalah K, Pantuck AJ, Rioux-Leclercq N, Thuret R, Montorsi F, Karakiewicz PI, et al. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. Eur Urol. 2010;57(3):466–71.CrossRefPubMedGoogle Scholar
  41. 41.
    Kwon EO, Carver BS, Snyder ME, Russo P. Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours. BJU Int. 2007;99(2):286–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Kheterpal E, Taneja SS. Partial nephrectomy: contemporary outcomes, candidate selection, and surgical approach. Urol Clin North Am. 2012;39(2):199–210, vii.CrossRefPubMedGoogle Scholar
  43. 43.
    Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000;163(2):442–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Woldu SL, Barlow LJ, Patel T, Hruby GW, Benson MC, McKiernan JM. Single institutional experience with nephron-sparing surgery for pathologic stage T3bNxM0 renal cell carcinoma confined to the renal vein. Urology. 2010;76(3):639–42.CrossRefPubMedGoogle Scholar
  45. 45.
    Ramaswamy K, Kheterpal E, Pham H, Mohan S, Stifelman M, Taneja S, et al. Significance of pathologic T3a upstaging in clinical T1 renal masses undergoing nephrectomy. Clin Genitourin Cancer. 2015;13(4):344–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Najarian JS, Chavers BM, McHugh LE, Matas AJ. 20 years or more of follow-up of living kidney donors. Lancet. 1992;340(8823):807–10.CrossRefPubMedGoogle Scholar
  47. 47.
    Fehrman-Ekholm I, Dunér F, Brink B, Tydén G, Elinder CG. No evidence of accelerated loss of kidney function in living kidney donors: results from a cross-sectional follow-up. Transplantation. 2001;72(3):444–9.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7(9):735–40.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Bijol V, Mendez GP, Hurwitz S, Rennke HG, Nosé V. Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure. Am J Surg Pathol. 2006;30(5):575–84.CrossRefPubMedGoogle Scholar
  50. 50.
    Butler BP, Novick AC, Miller DP, Campbell SA, Licht MR. Management of small unilateral renal cell carcinomas: radical versus nephron-sparing surgery. Urology. 1995;45(1):34–40-41.CrossRefPubMedGoogle Scholar
  51. 51.
    McKiernan J, Simmons R, Katz J, Russo P. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology. 2002;59(6):816–20.CrossRefPubMedGoogle Scholar
  52. 52.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461–70.CrossRefGoogle Scholar
  53. 53.
    Stevens LA, Coresh J, Feldman HI, Greene T, Lash JP, Nelson RG, et al. Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol. 2007;18(10):2749–57.CrossRefPubMedGoogle Scholar
  54. 54.
    Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247–54.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Weight CJ, Larson BT, Gao T, Campbell SC, Lane BR, Kaouk JH, et al. Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival. Urology. 2010;76(3):631–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038–47.CrossRefPubMedGoogle Scholar
  57. 57.
    United States Renal Data System. 2017 annual data report [Internet]. [cited 2018 Jun 16]. Available from:
  58. 58.
    Murphy D, McCulloch CE, Lin F, Banerjee T, Bragg-Gresham JL, Eberhardt MS, et al. Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med. 2016;165(7):473–81.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379(9811):165–80.CrossRefPubMedGoogle Scholar
  60. 60.
    Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.CrossRefGoogle Scholar
  61. 61.
    Lane BR, Demirjian S, Weight CJ, Larson BT, Poggio ED, Campbell SC. Performance of the chronic kidney disease-epidemiology study equations for estimating glomerular filtration rate before and after nephrectomy. J Urol. 2010;183(3):896–901.CrossRefPubMedGoogle Scholar
  62. 62.
    Matsushita K, Mahmoodi BK, Woodward M, Emberson JR, Jafar TH, Jee SH, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA. 2012;307(18):1941–51.CrossRefPubMedGoogle Scholar
  63. 63.
    Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med. 1974;290(13):697–701.CrossRefPubMedGoogle Scholar
  64. 64.
    Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Shlipak MG, Fried LF, Cushman M, Manolio TA, Peterson D, Stehman-Breen C, et al. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA. 2005;293(14):1737–45.CrossRefPubMedGoogle Scholar
  66. 66.
    Pun PH, Smarz TR, Honeycutt EF, Shaw LK, Al-Khatib SM, Middleton JP. Chronic kidney disease is associated with increased risk of sudden cardiac death among patients with coronary artery disease. Kidney Int. 2009;76(6):652–8.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Bae EH, Lim SY, Cho KH, Choi JS, Kim CS, Park JW, et al. GFR and cardiovascular outcomes after acute myocardial infarction: results from the Korea Acute Myocardial Infarction Registry. Am J Kidney Dis. 2012;59(6):795–802.CrossRefPubMedGoogle Scholar
  68. 68.
    Weiner DE, Tighiouart H, Stark PC, Amin MG, MacLeod B, Griffith JL, et al. Kidney disease as a risk factor for recurrent cardiovascular disease and mortality. Am J Kidney Dis. 2004;44(2):198–206.CrossRefPubMedGoogle Scholar
  69. 69.
    Fried LF, Katz R, Sarnak MJ, Shlipak MG, Chaves PHM, Jenny NS, et al. Kidney function as a predictor of noncardiovascular mortality. J Am Soc Nephrol. 2005;16(12):3728–35.CrossRefPubMedGoogle Scholar
  70. 70.
    Buzello M, Törnig J, Faulhaber J, Ehmke H, Ritz E, Amann K. The apolipoprotein e knockout mouse: a model documenting accelerated atherogenesis in uremia. J Am Soc Nephrol. 2003;14(2):311–6.CrossRefPubMedGoogle Scholar
  71. 71.
    Glodny B, Nasseri P, Rehder P, Unterholzner V, Plaikner M, Koppelstätter C, et al. Reduced glomerular filtration rate due to loss of nephron mass may be an independent risk factor for atherosclerosis. Nephrol Dial Transplant. 2011;26(6):1882–7.CrossRefPubMedGoogle Scholar
  72. 72.
    Stefanski A, Schmidt KG, Waldherr R, Ritz E. Early increase in blood pressure and diastolic left ventricular malfunction in patients with glomerulonephritis. Kidney Int. 1996;50(4):1321–6.CrossRefPubMedGoogle Scholar
  73. 73.
    Converse RL Jr, Jacobsen TN, Toto RD, Jost CM, Cosentino F, Fouad-Tarazi F, et al. Sympathetic overactivity in patients with chronic renal failure. N Engl J Med. 1992;327:1912–8. [Internet]. [cited 2018 Jun 16]. Available from: Scholar
  74. 74.
    Campese VM, Kogosov E. Renal afferent denervation prevents hypertension in rats with chronic renal failure. Hypertension. 1995;25(4 Pt 2):878–82.CrossRefPubMedGoogle Scholar
  75. 75.
    Kronenberg F, Kuen E, Ritz E, Junker R, König P, Kraatz G, et al. Lipoprotein(a) serum concentrations and apolipoprotein(a) phenotypes in mild and moderate renal failure. J Am Soc Nephrol. 2000;11(1):105–15.PubMedGoogle Scholar
  76. 76.
    Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008;179(2):468–71; discussion 472–3.CrossRefPubMedGoogle Scholar
  77. 77.
    Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181(1):55–61; discussion 61–2.CrossRefPubMedGoogle Scholar
  78. 78.
    Zini L, Perrotte P, Capitanio U, Jeldres C, Shariat SF, Antebi E, et al. Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer. 2009;115(7):1465–71.CrossRefPubMedGoogle Scholar
  79. 79.
    Tan H-J, Norton EC, Ye Z, Hafez KS, Gore JL, Miller DC. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012;307(15):1629–35.CrossRefPubMedGoogle Scholar
  80. 80.
    Weight CJ, Larson BT, Fergany AF, Gao T, Lane BR, Campbell SC, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol. 2010;183(4):1317–23.CrossRefPubMedGoogle Scholar
  81. 81.
    Lane BR, Campbell SC, Demirjian S, Fergany AF. Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease. J Urol. 2013;189(5):1649–55.CrossRefPubMedGoogle Scholar
  82. 82.
    Lane BR, Demirjian S, Derweesh IH, Takagi T, Zhang Z, Velet L, et al. Survival and functional stability in chronic kidney disease due to surgical removal of nephrons: importance of the new baseline glomerular filtration rate. Eur Urol. 2015;68(6):996–1003.CrossRefPubMedGoogle Scholar
  83. 83.
    Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H. Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol. 2014;65(2):372–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Poulakis V, Witzsch U, de Vries R, Moeckel M, Becht E. Quality of life after surgery for localized renal cell carcinoma: comparison between radical nephrectomy and nephron-sparing surgery. Urology. 2003;62(5):814–20.CrossRefPubMedGoogle Scholar
  85. 85.
    Novara G, Secco S, Botteri M, De Marco V, Artibani W, Ficarra V. Factors predicting health-related quality of life recovery in patients undergoing surgical treatment for renal tumors: prospective evaluation using the RAND SF-36 Health Survey. Eur Urol. 2010;57(1):112–20.CrossRefPubMedGoogle Scholar
  86. 86.
    Clark PE, Schover LR, Uzzo RG, Hafez KS, Rybicki LA, Novick AC. Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue. Urology. 2001;57(2):252–6.CrossRefPubMedGoogle Scholar
  87. 87.
    Link RE, Bhayani SB, Allaf ME, Varkarakis I, Inagaki T, Rogers C, et al. Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass. J Urol. 2005;173(5):1690–4.CrossRefPubMedGoogle Scholar
  88. 88.
    Ray ER, Turney BW, Singh R, Chandra A, Cranston DW, O’Brien TS. Open partial nephrectomy: outcomes from two UK centres. BJU Int. 2006;97(6):1211–5.CrossRefPubMedGoogle Scholar
  89. 89.
    Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178(1):41–6.CrossRefPubMedGoogle Scholar
  90. 90.
    Sun M, Bianchi M, Trinh QD, Abdollah F, Schmitges J, Jeldres C, Shariat SF, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI. Hospital volume is a determinant of postoperative complications, blood transfusion and length of stay after radical or partial nephrectomy. J Urol. 2012;187(2):405–10. Epub 2011 Dec 15.CrossRefPubMedGoogle Scholar
  91. 91.
    Haseebuddin M, Benway BM, Cabello JM, Bhayani SB. Robot-assisted partial nephrectomy: evaluation of learning curve for an experienced renal surgeon. J Endourol. 2010;24(1):57–61.CrossRefPubMedGoogle Scholar
  92. 92.
    Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol. 2009;182(3):866–72.CrossRefPubMedGoogle Scholar
  93. 93.
    Miller DC, Hollingsworth JM, Hafez KS, Daignault S, Hollenbeck BK. Partial nephrectomy for small renal masses: an emerging quality of care concern? J Urol. 2006;175(3 Pt 1):853–7; discussion 858.CrossRefPubMedGoogle Scholar
  94. 94.
    Kim SP, Shah ND, Weight CJ, Thompson RH, Moriarty JP, Shippee ND, et al. Contemporary trends in nephrectomy for renal cell carcinoma in the United States: results from a population based cohort. J Urol. 2011;186(5):1779–85.CrossRefPubMedGoogle Scholar
  95. 95.
    Patel SG, Penson DF, Pabla B, Clark PE, Cookson MS, Chang SS, et al. National trends in the use of partial nephrectomy: a rising tide that has not lifted all boats. J Urol. 2012;187(3):816–21.CrossRefPubMedGoogle Scholar
  96. 96.
    Huang WC, Atoria CL, Bjurlin M, Pinheiro LC, Russo P, Lowrance WT, et al. Management of small kidney cancers in the new millennium: contemporary trends and outcomes in a population-based cohort. JAMA Surg. 2015;150(7):664–72.CrossRefPubMedGoogle Scholar
  97. 97.
    Sivarajan G, Huang WC. Current practice patterns in the surgical management of renal cancer in the United States. Urol Clin North Am. 2012;39(2):149–60, v.CrossRefPubMedGoogle Scholar
  98. 98.
    Thompson RH, Kaag M, Vickers A, Kundu S, Bernstein M, Lowrance W, et al. Contemporary use of partial nephrectomy at a tertiary care center in the United States. J Urol. 2009;181(3):993–7.CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    Zini L, Patard JJ, Capitanio U, Mejean A, Villers A, de La Taille A, et al. The use of partial nephrectomy in European tertiary care centers. Eur J Surg Oncol. 2009;35(6):636–42.CrossRefPubMedGoogle Scholar
  100. 100.
    Dulabon LM, Lowrance WT, Russo P, Huang WC. Trends in renal tumor surgery delivery within the United States. Cancer. 2010;116(10):2316–21.PubMedPubMedCentralGoogle Scholar
  101. 101.
    Satasivam P, Rajarubendra N, Chia PH, Munshey A, Sengupta S, Bolton D. Trends in the use of of nephron-sparing surgery (NSS) at an Australian tertiary referral centre: an analysis of surgical decision-making using the R.E.N.A.L. nephrometry scoring system. BJU Int. 2012;109(9):1341–4.CrossRefPubMedGoogle Scholar
  102. 102.
    Rifkin DE, Shlipak MG, Katz R, Fried LF, Siscovick D, Chonchol M, et al. Rapid kidney function decline and mortality risk in older adults. Arch Intern Med. 2008;168(20):2212–8.CrossRefPubMedPubMedCentralGoogle Scholar
  103. 103.
    Shlipak MG, Katz R, Kestenbaum B, Siscovick D, Fried L, Newman A, et al. Rapid decline of kidney function increases cardiovascular risk in the elderly. J Am Soc Nephrol. 2009;20(12):2625–30.CrossRefPubMedPubMedCentralGoogle Scholar
  104. 104.
    Snyder ME, Bach A, Kattan MW, Raj GV, Reuter VE, Russo P. Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. J Urol. 2006;176(6 Pt 1):2391–5, 2396.CrossRefPubMedGoogle Scholar
  105. 105.
    Abouassaly R, Alibhai SMH, Tomlinson G, Timilshina N, Finelli A. Unintended consequences of laparoscopic surgery on partial nephrectomy for kidney cancer. J Urol. 2010;183(2):467–72.CrossRefPubMedGoogle Scholar
  106. 106.
    Breau RH, Crispen PL, Jimenez RE, Lohse CM, Blute ML, Leibovich BC. Outcome of stage T2 or greater renal cell cancer treated with partial nephrectomy. J Urol. 2010;183(3):903–8.CrossRefPubMedGoogle Scholar
  107. 107.
    Weight CJ, Lythgoe C, Unnikrishnan R, Lane BR, Campbell SC, Fergany AF. Partial nephrectomy does not compromise survival in patients with pathologic upstaging to pT2/pT3 or high-grade renal tumors compared with radical nephrectomy. Urology. 2011;77(5):1142–6.CrossRefPubMedGoogle Scholar
  108. 108.
    Campbell SC, Uzzo RG, Allaf ME, et al. Renal mass and localized renal cancer: AUA Guideline. J Urol. 2017;198(3):520–9.CrossRefGoogle Scholar
  109. 109.
    Finelli A, Ismaila N, Bro B, et al. Management of small renal masses: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017;35(6):668–80.CrossRefPubMedGoogle Scholar
  110. 110.
    Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24.CrossRefGoogle Scholar
  111. 111.
    NCCN clinical practice guidelines in oncology (NCCN Guidelines®) kidney cancer. Version 1.2018 [Internet]. Available from:

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

Personalised recommendations