Nephron-sparing surgery for tumors in a solitary kidney

Presence of a tumor in a solitary kidney is an absolute indication for performing nephron-sparing surgery (NSS). In the past two decades, new modalities for treatment of small renal mass have emerged but despite their evolution and promising results, partial nephrectomy remains the cornerstone of surgical treatment in this setting. Herein, we review the literature surrounding NSS in patients with a solitary kidney.

Data from large retrospective, single and multi-institutional series indicate that open partial nephrectomy in patients with a solitary kidney can achieve oncological control as well as renal function preservation with acceptable complication profile. Available data indicate that employing parenchymal cooling can mitigate the deleterious effects of prolonged clamp time during partial nephrectomy. Introduction of laparoscopic and, more recently, robotic approach have allowed minimally invasive approach in selected patients undergoing partial nephrectomy. Large comparative studies comparing minimally invasive approaches to open technique are lacking.

Established and emerging NSS techniques along with our better understating of the factors affecting function after surgery have fostered improvement of delivery of care in the setting of renal tumor(s) in a solitary kidney. Future developments should focus on minimizing the invasiveness of treatments while further improving cancer control and functional preservation.