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Open partial nephrectomy: an essential contemporary operation

Nature Clinical Practice Urology volume 3, pages 2–3 (2006)Cite this article

Over the last 15 years, we have learned that renal cortical tumors (RCTs) are members of a complex family of lesions with a specific histology, cytogenetic defects, and variable metastatic potential ranging from benign oncocytomas, to indolent papillary and chromophobe carcinomas, and the more malignant conventional clear-cell carcinomas.1 Approximately 30% of patients with RCT present with large, symptomatic, locally advanced and/or metastatic tumors, and a guarded or poor prognosis. These patients require radical nephrectomy, regional lymphadenectomy, and adrenalectomy by open or laparoscopic surgery. The remaining 70% of RCTs are discovered incidentally. This has led to a tumor size and stage migration (median 4.5 cm, T1b), and a large pool of patients with an excellent prognosis (survival rates of >90%, depending on tumor histology). Despite modern imaging techniques, 20–30% of patients have a benign lesion or oncocytoma upon surgical resection.2 Unfortunately, current percutaneous biopsy techniques are not sufficiently accurate (only 70%) to determine tumor histology, but more specific molecular and immunohistochemical probes are being developed.3

Recent trends in surgical oncology favor organ preservation, often with adjuvant therapies, to provide equivalent local tumor control and long-term survival to their more radical counterparts. Over the last decade, kidney-preserving partial nephrectomy, once restricted to tumors in patients with a solitary kidney or with renal insufficiency or disease, has become an accepted alternative to radical nephrectomy, even for patients with both kidneys intact. Studies have shown that partial nephrectomy for tumors of ≤4 cm provides equivalent tumor control to radical nephrectomy.4 Previous deterrents to partial nephrectomy, including proximity to the collecting system, endophytic tumor location, concern for tumor multifocality, and desire for a 1 cm surgical margin, have been addressed. Surgical entry into the collecting system with suture repair and adequate retroperitoneal drainage is not associated with excessive morbidity. With careful visual inspection and intraoperative ultrasound, a previously unrecognized tumor satellite (<5% risk of occurrence) can be excised intraoperatively. Gross resection by tumor enucleation, even with only microscopically negative surgical margins, provides excellent local tumor control. When technically feasible, partial nephrectomy for tumors of ≤7 cm produces equivalent disease-free intervals to those achieved in similar patients treated with radical nephrectomy, across all histologic subtypes.5 Two important studies have demonstrated that long-term renal function is adversely affected by radical nephrectomy.6,7 Aging patients, and those with or who later develop common comorbid conditions such as hypertension and diabetes, especially benefit from kidney sparing. At our center, >65% of RCT patients undergo partial nephrectomy. After the procedure, patients remain under close surveillance for their 5% lifetime risk of ipsilateral and contralateral new tumor formation. The complication rate of open partial nephrectomy is 9%, the most bothersome adverse events being prolonged urinary fistula and delayed hemorrhage, which rarely require surgery.8

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References

  1. Linehan WM et al. (2003) The genetic basis of cancer of the kidney. J Urol 170: 2163–2172

    Article  CAS  Google Scholar 

  2. McKiernan J et al. (2002) Partial nephrectomy for renal cortical tumors: pathologic findings and impact on outcome. Urology 60: 1003–1009

    Article  Google Scholar 

  3. Dechet CB et al. (2003) Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol 169: 71–74

    Article  Google Scholar 

  4. Lee CT et al. (2000) Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol 163: 730–736

    Article  CAS  Google Scholar 

  5. Leibovich BC et al. (2004) Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm resulting in outcome similar to radical nephrectomy. J Urol 171: 1066–1070

    Article  Google Scholar 

  6. Lau WK et al. (2000) Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75: 1236–1242

    Article  CAS  Google Scholar 

  7. McKiernan J et al. (2002) Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 59: 816–820

    Article  Google Scholar 

  8. Stephenson AJ et al. (2004) Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 171: 130–134

    Article  Google Scholar 

  9. Scherr DS et al. (2003) Practice patterns among urologic surgeons treating localized renal cell carcinoma in the laparoscopic age: technology versus oncology. Urology 62: 1007–1011

    Article  Google Scholar 

  10. Gill IS et al. (2002) Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 167: 469–476

    Article  Google Scholar 

  11. Ramani AP et al. (2005) Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 173: 42–47

    Article  Google Scholar 

  12. Kim FJ et al. Laparoscopic radical versus partial nephrectomy: assessment of complications. J Urol 170: 408–411

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  1. Associate Attending Surgeon in the Department of Urology of Memorial Sloan–Kettering Cancer Center, NY, USA

    Paul Russo

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  1. Paul Russo
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Correspondence to Paul Russo.

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Russo, P. Open partial nephrectomy: an essential contemporary operation. Nat Rev Urol 3, 2–3 (2006). https://doi.org/10.1038/ncpuro0382

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