Open partial nephrectomy: ancient art or currently available technique?

Abstract

Renal cell carcinoma (RCC) accounts for 3 % of adult solid tumors, with the highest incidence between 50 and 70 years of age. Nephron-sparing surgery was initially reserved to patients with small renal masses detected in anatomically or functionally solitary kidney or in the presence of multiple bilateral tumors or hereditary forms of RCC, which posed a high risk of developing a tumor in the contralateral kidney. Nowadays, partial nephrectomy (PN) has grown up to an established approach for the treatment of small renal masses. In patients with T1a-staged RCCs, PN has proven to be associated with better survival, long-term renal function preservation with lower dialysis need or renal transplantation. Currently, most of the kidney masses are incidentally detected, up to 40 %, with smaller size due to the widespread use of imaging modalities such as ultrasound, computed tomography and magnetic resonance. Here we review the role of open PN in the management of small renal masses particularly focusing on indications, oncological outcomes and comparison with laparoscopic and robotic PN. Recent studies demonstrate that PN confers better survival, oncologic equivalence and lower risk of severe chronic kidney disease compared to radical nephrectomy becoming then the gold-standard surgical technique, even if increasingly challenged by laparoscopic and/or robot-assisted partial nephrectomy which in the hands of experts seems to achieve comparable outcome results albeit with slightly higher complication rate.

Open versus robotic partial nephrectomy: Systematic review and meta‐analysis of contemporary studies

“…To include as many eligible articles as possible, we did not set any limitation term during literature search strategy except for only limitation of language of English written. To expand the potentially eligible articles, we searched for articles from the reference lists of specific review and original articles relevant to current topic …”

“…To expand the potentially eligible articles, we searched for articles from the reference lists of specific review and original articles relevant to current topic. 6,13,14 papers with abstract only. If two or more studies were presented in an overlapping time by the same authors and/or same institution, the study in which the largest number of patients and/or articles provided the more comprehensive information and/or the most recently published study were used.…”

Histopathologic Features of Kidney Tumors and Comparison of Patients Treated with Radical and Partial Nephrectomy at Osijek University Hospital Center from 2017 until the end of 2021

“…The subject of RN versus PN has been thoroughly evaluated in countless previous studies and metaanalyses [21][22][23][24] . Themes such as overall-and cancerspecific survival, as well as oncologic outcome altogether, complication rate, postoperative renal function, positive margin rate, length of hospital stay and intraoperative blood loss have been compared between the two techniques for open, laparoscopic and robot-assisted procedures [25][26][27][28][29][30][31][32][33] . Based primarily on surgical experience and availability of surgical tools, PN can be done with any of the three mentioned modalities 1 .…”

Open partial nephrectomy: current review

“…Where time of resection is likely to be less than 20-25 minutes, CI is not necessary as there is no increased risk of acute or chronic renal injury and risk of permanent dialysis secondary to warm ischemia during this time (49). When compared to laparoscopic and robotic approaches, OPN has generally has a shorter warm ischemia time in published studies (50). With improved surgical expertise in robotic PN however, this is becoming more comparable.…”