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A Novel Surgical Technique As a Foundation for In Vivo Partial Liver Engineering in Rat
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Open partial nephrectomy: an essential operation with an expanding role.

Paul Russo1

  • 1Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York 10021, USA. RussoP@MSKCC.org

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Summary

Partial nephrectomy offers comparable cancer control to radical nephrectomy for small kidney tumors. This kidney-sparing surgery preserves renal function and prevents chronic kidney disease progression.

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Area of Science:

  • Nephrology
  • Oncology
  • Urology

Background:

  • Renal tumors encompass a spectrum from benign to malignant, with clear cell carcinomas being the most common and metastatic.
  • Early detection due to stage migration leads to a high incidence of incidentally found small renal masses (median size < 4.0 cm).
  • Pre-existing chronic kidney disease (CKD) affects 26% of patients undergoing renal tumor surgery and is a risk factor for cardiovascular disease and mortality.

Purpose of the Study:

  • To review the evidence supporting the expanded use of partial nephrectomy for renal cortical tumors.
  • To highlight the benefits of nephron-sparing surgery in preserving renal function.
  • To emphasize the role of partial nephrectomy in preventing or mitigating chronic kidney disease.

Main Methods:

  • Review of contemporary literature on renal tumor treatment.
  • Comparative analysis of oncological outcomes and renal function preservation between partial and radical nephrectomy.
  • Assessment of the impact of nephrectomy on chronic kidney disease progression.

Main Results:

  • Partial nephrectomy (PN) for tumors ≤7 cm provides oncological control equivalent to radical nephrectomy (RN).
  • PN maximizes preservation of long-term renal function compared to RN.
  • Patients undergoing PN had a 95% likelihood of maintaining a glomerular filtration rate (GFR) ≥45 ml/min/1.73 m², versus 64% after RN.

Conclusions:

  • Partial nephrectomy is a crucial surgical option for small renal tumors.
  • It achieves equivalent local tumor control to radical nephrectomy.
  • Partial nephrectomy is superior in preventing the onset or worsening of chronic kidney disease.