Changing concepts in the surgery of renal cell carcinoma

Herein, current developments in open and minimally invasive renal surgery are presented.

This also includes considerations on the appropriate indication for the two surgical procedures in small renal tumours, locally advanced disease (>pT2), complicated renal tumours as well as cytoreductive surgical situations. In small renal tumours, similar survival rates have been described for laparoscopic radical and partial nephrectomy. However, even experienced high volume laparoscopic centres report a high learning curve, increased complications and initial technical problems to achieve parenchymal haemostasis and renal ischaemia during nephron-sparing surgery. Surgical management of large (>T2) or complicated tumours is feasible, but long-term oncological outcome is not yet available.

Promising new developments such as natural orifice translumenal endoscopic surgery (NOTES) might add to our surgical armamentarium for minimally invasive surgery.