Nephron-sparing surgery: a call for greater application of established techniques

Area of Science:

• Urology
• Nephrology
• Surgical Oncology

Background:

• Nephron-sparing surgery, including open partial nephrectomy (OPN), is crucial for renal carcinoma treatment.
• OPN remains under-utilized despite its benefits, necessitating further evaluation.
• Minimally invasive techniques are increasingly prevalent, challenging the role of OPN.

Purpose of the Study:

• To evaluate the outcomes of open partial nephrectomy (OPN) over 15 years at a UK teaching hospital.
• To compare OPN results with existing literature, including minimally invasive approaches.
• To present a standardized OPN technique aimed at reducing postoperative urinoma.

Main Methods:

• Retrospective review of 141 patients undergoing OPN over 15 years by a single senior surgeon.
• Analysis included patients with imperative indications and those undergoing synchronous major surgery.
• Data collected on perioperative outcomes, complications, and long-term survival.

Main Results:

• 147 OPNs were performed, with 82 for imperative indications.
• Three perioperative deaths occurred, primarily in patients with concurrent major surgery.
• 38 patients experienced postoperative complications, including bleeding and dialysis requirements.
• A 90% cancer-specific survival rate was observed at a median 2-year follow-up.

Conclusions:

• This series supports the trend of improved outcomes and reduced complications with OPN.
• OPN remains a viable and effective option for renal carcinoma treatment.
• The findings advocate for the continued application of OPN despite the rise of minimally invasive surgery.