Open partial nephrectomy: an essential operation with an expanding role

To describe the rationale for expanding the role of partial nephrectomy in the treatment of renal cortical tumors.

Renal tumors are a family of neoplasms ranging from the benign oncocytoma, to the indolent papillary and chromophobe carcinomas, to the more potentially malignant clear cell carcinomas that account for 54% of the lesions resected, but 90% of those that metastasize. Due to a contemporary stage migration, 70% of the tumors are detected incidentally with a median tumor size of below 4.0 cm. Partial nephrectomy for tumors of 7 cm or less provides equivalent oncological tumor control to radical nephrectomy with maximum preservation of long-term renal function. Twenty-six percent of patients prior to operation already have stage 3 chronic kidney disease with an estimated glomerular filtration rate of less than 60 ml/min/1.73 m. Chronic kidney disease is an independent risk factor for the development of cardiovascular disease, hospitalization and death. The likelihood of freedom from a glomerular filtration rate of less than 45 was 95% after partial nephrectomy, but only 64% following radical nephrectomy.

Partial nephrectomy is an essential surgical approach to the small kidney tumor and provides equivalent local tumor control while preventing the new onset or worsening of chronic kidney disease.