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Rationale for Partial Nephrectomy

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Renal Cancer

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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. The proportion of these masses that are <4 cm is also rising, and currently, approximately 60 % of newly diagnosed renal masses are <4 cm, so-called small renal masses (SRMs). The primary treatment of small renal masses (SRMs) is prompt surgical excision because there is no curative medical therapy and since the natural history of renal masses is largely unknown. While curative extirpative surgery was traditionally accomplished by radical nephrectomy (RN), it is now recognized that in the population of patients with renal masses, this procedure has significant deleterious effects on postoperative renal function and may place patients at an increased risk of cardiovascular disease and death. Partial nephrectomy (PN), in contrast, carries a lower risk of long-term renal dysfunction and has demonstrated potentially lower risk of subsequent cardiovascular events and death while consistently demonstrating oncologic outcomes equivalent to RN. As such, elective PN is considered by many to be the standard treatment for pT1a renal masses as well as select pT1b renal masses as it provides an optimal strategy of maximizing oncologic control of malignant renal cortical tumors (RCTs) while preserving renal function and minimizing the long-term risks associated with a decreased number of functioning nephrons.

There are certain instances, when, for the patient’s well being, it is unwise to do a nephrectomy, even in the presence of a malignant growth involving the kidney. The question is, whether such a procedure is ever justifiable when the opposite kidney is normal. [1]

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Abbreviations

AS:

Active surveillance

CKD:

Chronic kidney disease

ESRD:

End-stage renal disease

LPN:

Laparoscopic partial nephrectomy

LRN:

Laparoscopic radical nephrectomy

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

RN:

Radical nephrectomy

RPN:

Robotic partial nephrectomy

SRMs:

Small renal masses

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  1. Department of Urology, NYU Langone Medical Center, 110 Third Avenue, Apt 17B, New York, NY, 10003, USA

    Nicholas Donin

  2. Department of Urology, Division of Urologic Oncology, NYU Langone Medical Center, New York, NY, USA

    William Huang

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    John A Libertino

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Donin, N., Huang, W. (2013). Rationale for Partial Nephrectomy. In: Libertino, J. (eds) Renal Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7236-0_11

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  • DOI: https://doi.org/10.1007/978-1-4614-7236-0_11

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  • Publisher Name: Springer, New York, NY

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  • Online ISBN: 978-1-4614-7236-0

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