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Oncological and renal medical importance of kidney-sparing surgery

Nature Reviews Urology volume 10, pages 292–299 (2013)Cite this article

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Abstract

In the past decade, the medical and oncological rationale for kidney-sparing surgical approaches for small renal masses has been clarified. Although radical nephrectomy is still necessary for many patients diagnosed with large renal tumours, accumulating evidence indicates that partial nephrectomy provides equivalent oncological outcomes while also preserving renal function and preventing the adverse cardiovascular effects of chronic kidney disease. Furthermore, approximately 45% of resected small renal tumours are benign or indolent, with limited—if any—metastatic potential. Patients who develop kidney cancer often have medical comorbidities that can affect kidney function, such as diabetes and hypertension, and histological examination of the non-tumour-bearing elements of the kidney demonstrate significant pathological changes in the vast majority of patients. For elderly patients or patients with comorbidities, active surveillance provides an alternative kidney-sparing approach, and is associated with extremely low rates of clinical disease progression and metastases. Despite these important advances in understanding, which support the use of partial nephrectomy for the treatment of small renal masses, the technique remains underused.

Key Points

  • Radical nephrectomy and partial nephrectomy provide equivalent oncological tumour control for the management of small (T1) renal masses

  • Approximately 45% of resected small renal tumours are benign or indolent, with limited metastatic potential

  • Radical nephrectomy is far more likely to cause or worsen pre-existing chronic kidney disease than partial nephrectomy

  • Chronic kidney disease—which is often present in patients with kidney tumours secondary to hypertension and diabetes—is associated with adverse cardiovascular events and poor overall survival

  • Despite strong clinical evidence supporting partial nephrectomy as the preferred surgical approach for small renal tumours, the technique is grossly underused

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Russo, P. Oncological and renal medical importance of kidney-sparing surgery. Nat Rev Urol 10, 292–299 (2013). https://doi.org/10.1038/nrurol.2013.34

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