Comparison of Tumor Enucleation and Resection in Partial Nephrectomy: A Pathology-Based Volumetric Study of...

Partial nephrectomy is the preferred treatment for localized renal cell carcinoma when technically feasible. Tumor excision can be performed by either enucleation or resection. The impact of these techniques on parenchymal preservation and clinical outcomes remains controversial. This study aimed to compare tumor enucleation and tumor resection techniques in terms of volumetric, functional, and oncological outcomes.

We retrospectively analyzed 142 patients who underwent partial nephrectomy between 2020 and 2024. Patients were grouped according to excision technique: enucleation (n = 54) and resection (n = 88). Tumor volume, specimen volume, and excised tumor-free renal parenchymal volume were calculated from pathological specimens. Renal function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR) preoperatively and postoperatively. Oncological outcomes were evaluated based on pathological findings and postoperative imaging.

Baseline demographic, clinical, and surgical characteristics were comparable between groups. Specimen volume and excised tumor-free parenchymal volume were significantly greater in the resection group (P < .001). Both groups demonstrated a significant postoperative decline in renal function, with subsequent stabilization during follow-up. Early eGFR decline tended to be greater in the resection group but did not reach statistical significance. Positive surgical margin rates were similar between the enucleation and resection groups (16.7% versus 18.2%, P = 1.000). No local recurrence or distant metastasis was observed during the 2-year follow-up.

Tumor enucleation and resection demonstrated comparable short-term oncological outcomes. Enucleation was associated with reduced excision of tumor-free renal parenchyma and may offer a functional advantage. Larger prospective studies are needed to confirm these findings.