Renal sparing surgery.
Partial nephrectomy recommended for renal cancer with lesion 4 cm or less in size or if a radical resection of the kidney would lead to a need for dialysis.
Increasing being used in patients with T1a and T1b renal tumors up to 7 cm in greatest diameter and a normal contralateral kidney, with equivalent outcomes to radical nephrectomy.
Radical nephrectomy should not be used when a nephron sparing procedure can be achieved.
Techniques include enucleation, segmental nephrectomy, wedge resection, and extracorporeal partial nephrectomy with auto renal transplantation.
Radical nephrectomy associated with increased risk of chronic kidney disease, and for risks of cardiovascular disease and mortality.
A higher likelihood of partial nephrectomy associated with NE region of US, population greater than 500,000, oncology subspecialty, higher annual surgeon volume, and more recent year of certification.
Partial nephrectomy can achieve preserved renal function, decreased overall mortality, and reduced overall mortality, and reduced frequency of cardiovascular events.
At least 20% of renal function in 1 kidney must be preserved to avoid renal failure.
Renal cancer does not become symptomatic until late in its course.
Renal cancer lesions detected incidentally tend to be smaller and of lesser grade and, thus, more amenable to conservative surgery.
Long term survival comparable to that obtained after radical nephrectomy for renal cell cancer.
Now replacing radical nephrectomy as the surgical treatment of choice for renal cancer.
Allows for equivalent cancer treatment and minimize nephron loss in the 10% of patients that have a benign lesion on final biopsy.
Indications for the procedure include synchronous bilateral tumors, tumors in a solitary kidney, and the presence of a poorly functional contralateral renal unit are generally indications for nephron-sparing surgery.
The concomitant presence of unilateral renal cell cancer and contralateral kidney abnormalities with renal arterial disease, chronic pyelonephritis, calculus disease, and the presence of diabetes is also an indication for NSS.
Partial nephrectomy is standard of care for clinical stage T1 renal mass.
Oncological outcomes for laparoscopic versus open nephron sparing surgery are similar with metastasis free survival at 7 years at about 97%.
A higher likelihood of partial nephrectomy in NE US, high population centers, higher surgical volumes and more recent year of certification.
In a EORTC 30904 study randomized patients with renal cell cancer to partial nephrectomy or radical nephrectomy in more than 500 patients with small renal tumors of less than 5 cm and a normal contralateral kidney: Partial nephrectomy associated with more perioperative morbidity and a 10 year overall survival better in the radical nephrectomy group 81% versus 76%, and cardiovascular events more common in the partial nephrectomy group.
The goal of nephron sparing surgery is optimal locoregional control while minimizing ischemia time to below 30 minutes.