Partial nephrectomy for solid renal masses in polycystic kidneys: open surgical technique

Partial nephrectomy for small renal masses is well established as the preferred means of surgical treatment for kidney cancer, to preserve renal function. Although minimally invasive techniques are now standard in many countries, open surgery remains an important technique for difficult cases. Partial nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is challenging and not widely reported. We describe the open surgical technique for partial nephrectomy in patients with multicystic kidneys who are not on renal replacement therapy (RRT). We illustrate the technique using three cases of patients with multicystic kidneys and solid renal masses. All had early chronic kidney disease, making partial nephrectomy for suspected kidney cancer the preferred strategy. The patients had stable creatinine and were recurrence-free at last follow-up. Open partial nephrectomy remains an important surgical technique for resection of challenging kidney tumours, such as those in multicystic kidneys. Patients with ADPKD and solid renal masses who are not on RRT should be managed in the same manner as the background population, with nephron-sparing surgery wherever possible.