Partial nephrectomy—contemporary indications, techniques and outcomes

Abstract

Increased detection of the small renal mass over the last two decades has led to greater utilization of partial nephrectomy techniques. Appreciation of the negative impact of chronic renal impairment has resulted in partial nephrectomy surpassing radical nephrectomy as the preferred treatment for technically feasible lesions. Indeed the management of localized renal tumours has become focused on techniques that maximally preserve nephron quantity and quality, and therefore maximize renal function after surgery. Postoperative renal function is determined primarily by three factors: preoperative renal function, volume of renal mass preserved and surgical renal ischaemia. Minimization of surgical ischaemia is achieved by early unclamping and unclamped (zero ischaemia) techniques. In addition, laparoscopic and robotic approaches to nephron-sparing surgery have significantly reduced the morbidity of the partial nephrectomy procedure compared with the traditional open approach. The contemporary techniques used for partial nephrectomy demonstrate excellent renal functional and oncological outcomes and minimize perioperative complications.

Modified C index: Novel predictor of postoperative renal functional loss of laparoscopic partial nephrectomy

“…This finding is consistent with that of a previous study 20 and seems to be reasonable, because a larger resected volume also results in loss of functioning nephrons due to resection of normal parenchyma.…”

Standardized Reporting of Microscopic Renal Tumor Margins: Introduction of the Renal Tumor Capsule Invasion Scoring System

“…1 The literature has demonstrated the amount of parenchyma spared during these resections can directly correlate to improved long-term functional outcomes. 15,16 In light of these observations, parenchymal function preservation has been pursued through means of focusing on either reduction in warm ischemic time or maximization of spared renal parenchyma tissue during extraction.…”

“…1,2 Tumor enucleation (TE) is a nephron sparing surgical technique, commonly employed in patients with hereditary renal syndromes, which maximally preserves normal renal parenchyma. 3 Recently, a tumor enucleation approach has become more prevalent in the surgical management of sporadic renal masses with promising initial results.…”

Parcial Nephrectomies - results of 12 years from an Oncology Institution

“…3,4 Although there is some controversy on the true values of mortality rate of RCC, it seems that mortality rates are decreasing. 5,6 Currently the cornerstone treatment of T1a tumors is partial nephrectomy (PN), and this is supported in the European Association of Urology Guidelines on Renal Cell Carcinoma albeit nephron-sparing surgery is indicated for tumors up to 7 cm diameter, whenever technically feasible. 7,8 Long-term studies have shown that PN has oncological outcomes comparable to those obtained after radical nephrectomy (RN), while reducing the risk of de novo chronic kidney disease (CKD).…”

“…Post-operative mortality is also low with only one case due to septic shock. 6,28 Tumor size in our series is also worth mentioning; with an average of 2.9 cm it also includes 30 cases with more than 4 cm. One anecdotal case refers to a tumor with 13 cm corresponding to an angiomyolipoma that was feasible to extract.…”