Current status and advances in nephron-sparing surgery

Localized renal cell carcinoma (RCC) remains a surgical disease, with excision of the tumor or tumor-bearing kidney offering the only chance of cure for affected patients. After the widespread acceptance of partial nephrectomy as equivalent treatment to radical nephrectomy in appropriately selected cases of RCC, a range of nephron-sparing procedures has become available to patients. These include laparoscopic partial nephrectomy, thermal ablative techniques, as well as open partial nephrectomy. These techniques offer the attraction of being minimally invasive, in some cases as outpatient procedures under sedation. This review attempts to clarify the current status of these nephron-sparing techniques. Case selection criteria, outcomes, and complications are presented with the aim of helping the modern urologist appreciate the benefits of these procedures as well as their limitations and role in the management of patients with RCC.