The Indications for Partial Nephrectomy in the Treatment of Renal Cell Carcinoma

Summary and Introduction

Summary

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.

Introduction

Renal cell carcinoma (RCC) accounts for 3% of all adult deaths from cancer in the US. Epidemiologic studies demonstrate a rise in RCC incidence rate of 2.3-4.3% annually in the US between 1975 and 1995.^[1] This phenomenon is explained by the increased number of RCC tumors detected as a result of the widespread use of noninvasive abdominal imaging modalities, such as ultrasound, CT and MRI.^[2] Although radical nephrectomy (RN), as described by Robson et al. has been the 'gold standard' treatment for patients with RCC for many decades, there is an increasing trend towards use of nephron-sparing surgery (NSS) and minimally invasive approaches.^[3] This evolution is the result of improved surgical technique, standardized staging, advanced radiologic imaging, and the downward migration of disease severity toward diagnoses of asymptomatic, incidental, smaller, and lower-stage lesions.^[4] This review focuses on the most recent reports on the indications, contraindications, advantages and disadvantages of NSS.