[Partial Nephrectomy and Focal Therapy in Small Renal Tumors]

With the increasing use of robot-assisted surgery, partial nephrectomy is recommended for small renal tumors(T1a)with a tumor size of 4 cm or less and is now considered a standard treatment. However, with the rise in incidental detection of small renal tumors during routine screenings, especially in elderly patients or those with comorbidities who may hesitate to undergo general anesthesia, there is a growing need for alternative treatments such as focal therapy to partial nephrectomy. The main methods of focal therapy include ablation techniques such as cryotherapy and radiofrequency ablation. Recently, stereotactic body radiotherapy has also been approved for insurance coverage, emerging as a minimally invasive option for renal cell carcinoma with a tumor size of 5 cm or less. Additionally, although not a focal therapy, active surveillance is also considered an effective option for very small renal tumors. Among these various treatment options, shared decision making between patients and healthcare providers, considering factors such as tumor characteristics and patient-specific conditions, is considered crucial in determining the appropriate treatment strategy for small renal tumors. In the absence of large-scale prospective comparative trials on partial nephrectomy, ablation therapy, stereotactic radiotherapy, and active surveillance, this paper provides an overview of the characteristics of each treatment modality and their respective outcomes and discusses the future perspectives in the treatment of small renal tumors.