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Updated: May 28, 2026
Single Port Donor Nephrectomy
Published on: March 12, 2011
Open partial nephrectomy. Personal technique and current outcomes
1Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA. RussoP@MSKCC.org
Abstract:
Modern imaging capabilities has created a renal tumor stage and size migration with approximately 70% of patients today detected incidentally with a median tumor size of 4cm or less. In addition, our current understanding indicates that renal cortical tumors are a family of neoplasms with distinct histopathological and cytogenetic features and variable metastatic potential.The conventional clear cell tumor has a malignant potential and accounts for only 54% of the total renal cortical tumors but 90% of those that metastasize. Radical nephrectomy, whether performed by open or minimally invasive surgical technique, plays an important role in the management of massive renal tumors that have replaced the normal renal parenchyma, invade the the renal vein, and have associated regional lymphadenopathy or metastatic disease. Partial nephrectomy has emerged as the treatment of choice for patients with smaller tumors. This operation can be performed through a "miniflank" surgical incision without rib resection. Complications related to partial nephrectomy, including bleeding, urinary fistula and infection occur in less than 10% of cases. Radical nephrectomy should not be performed for the treatment of small renal tumors since it is associated with the causation or worsening of preexisting CKD which can cause an increased likelihood of cardiovascular morbidity and mortality. Despite a wealth of evidence supporting the more restricted indications for RN, strong evidence exists that it remains over utilized in the United States. Widespread education and training in kidney preserving surgical strategies is essential going forward.
Insights
Partial nephrectomy is preferred for smaller renal tumors, while radical nephrectomy is reserved for extensive disease. Overutilization of radical nephrectomy for small tumors should be avoided to prevent chronic kidney disease progression.
Area of Science:
- Urology
- Nephrology
- Oncology
Background:
- Modern imaging detects most renal tumors incidentally, often smaller than 4cm.
- Renal cortical tumors are diverse, with clear cell type posing the highest metastatic risk.
Observation:
- Partial nephrectomy is the standard for smaller renal tumors, offering low complication rates (<10%).
- Radical nephrectomy is indicated for massive tumors invading critical structures or with metastasis.
Findings:
- Radical nephrectomy for small renal tumors can worsen chronic kidney disease (CKD), increasing cardiovascular risks.
- Despite evidence, radical nephrectomy is overutilized in the US for small renal tumors.
Implications:
- Prioritizing kidney-sparing partial nephrectomy for small tumors is crucial.
- Enhanced education on kidney-preserving surgical strategies is essential for urologists.
