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The indications for partial nephrectomy in the treatment of renal cell carcinoma

Nature Clinical Practice Urology volume 3, pages 198–205 (2006)Cite this article

Abstract

Partial nephrectomy is performed more frequently for small, incidentally discovered, low-stage renal tumors. Importantly, one should distinguish the imperative indications for such surgery from the relative and elective indications, while taking contraindications to nephron-sparing surgery into account. The main advantage of partial nephrectomy over radical nephrectomy is the avoidance of renal insufficiency; the major disadvantages include the possibility of local recurrence and perioperative complications. In this article, the literature on nephron-sparing surgery was reviewed in order to put the management of renal cancer into a modern perspective.

Key Points

  • Nephron-sparing surgery (NSS) for renal cell carcinoma has the advantage of reducing the risk of renal insufficiency by preserving kidney function; however, leaving the affected kidney in situ carries a risk of local recurrence

  • In patients with bilateral renal cell carcinoma, a solitary kidney, or impaired renal function in the contralateral kidney, every attempt should be made to preserve renal function

  • NSS is generally suitable for patients with single renal tumors of diameter 4 cm or less; candidates with larger or more complex tumors should be carefully selected

  • In order to avoid tumor recurrence it is important to ensure surgical margins are clear of disease; in patients with extensive tumor masses, or where lesions extend into the inferior vena cava or renal vein, partial nephrectomy is not recommended

  • Kidney damage due to warm ischemia is a problem when conducting NSS; renal hypothermia techniques can be used during surgery to limit its effect

  • Although still under development, laparoscopic partial nephrectomy techniques offer advantages to the patient compared with open surgery, reducing the need for postoperative pain medication and shortening hospital stay and recovery time

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Author information

Authors and Affiliations

  1. Consultant Urologist,

    Steven Joniau, Kathy Vander Eeckt & Hein Van Poppel

  2. Resident,

    Steven Joniau, Kathy Vander Eeckt & Hein Van Poppel

  3. Professor and Chairman at the Department of Urology, University Hospital Gasthuisberg, Leuven, Belgium

    Steven Joniau, Kathy Vander Eeckt & Hein Van Poppel

Authors
  1. Steven Joniau
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  2. Kathy Vander Eeckt
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  3. Hein Van Poppel
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Correspondence to Hein Van Poppel.

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Joniau, S., Vander Eeckt, K. & Van Poppel, H. The indications for partial nephrectomy in the treatment of renal cell carcinoma. Nat Rev Urol 3, 198–205 (2006). https://doi.org/10.1038/ncpuro0458

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