Contemporary status of open nephron-sparing surgery in renal cell carcinoma

The contemporary management of renal cell carcinoma (RCC) has changed significantly over the last decade. There has been a paradigm shift in the surgical strategy, especially for the treatment of small renal tumors using partial nephrectomy and minimal invasive techniques instead of radical neprectomy. The backgrounds are an enhanced awareness of the overall health as co-morbid conditions and overall morbidity. One such mechanism by which radical surgery of renal tumors might adversely influence overall health of the patients is by development or worsening of chronic kidney disease, a condition associated with cardiovascular disease and pre-mature death.

Previously nephron-sparing surgery was mostly used in imperative cases. An increased number of incidentally detected renal cell carcinomas are diagnosed due to the development and increased use of imaging techniques. These incidentally detected tumors generally tend to be smaller and having a lower stage.

The excellent results of partial nephrectomy in RCC with low operative morbidity and a good oncologic control, have promoted the use of nephron-sparing approach also in patients with a normal contralateral kidney and having tumors smaller than 4 and up to 7 cm.

Open partial nephrectomy has become the recommended technique in the treatment of properly selected patients.