Open partial nephrectomy: ancient art or currently available technique?

Area of Science:

• Urology
• Oncology
• Nephrology

Background:

• Renal cell carcinoma (RCC) is a significant adult solid tumor, often incidentally detected.
• Partial nephrectomy (PN) was initially for complex cases but is now standard for small renal masses.
• Technological advancements lead to earlier detection of smaller kidney masses.

Purpose of the Study:

• To review the role of open partial nephrectomy (PN) in managing small renal masses.
• To focus on indications, oncological outcomes, and comparisons with laparoscopic and robotic PN.
• To evaluate PN's effectiveness against radical nephrectomy for small renal masses.

Main Methods:

• Review of existing literature on open, laparoscopic, and robotic partial nephrectomy for small renal masses.
• Analysis of oncological outcomes, survival rates, and renal function preservation.
• Comparison of complication rates and long-term results across different surgical approaches.

Main Results:

• Partial nephrectomy (PN) demonstrates superior survival and renal function preservation compared to radical nephrectomy.
• PN is associated with a lower risk of chronic kidney disease and reduced need for dialysis or transplantation.
• Minimally invasive PN (laparoscopic/robotic) shows comparable oncological outcomes to open PN, potentially with higher complication rates in expert hands.

Conclusions:

• Partial nephrectomy is the gold-standard surgical technique for small renal masses, offering oncologic equivalence and improved renal function.
• Open PN remains a vital approach, while laparoscopic and robotic PN are increasingly viable alternatives.
• Continued research is needed to optimize surgical techniques and compare long-term outcomes across approaches.