Open partial nephrectomy: an essential operation with an expanding role.

Overview

PURPOSE OF REVIEW: To describe the rationale for expanding the role of partial nephrectomy in the treatment of renal cortical tumors. RECENT FINDINGS: Renal tumors are a family of neoplasms ranging from the benign oncocytoma, to the indolent papillary and chromophobe carcinomas, to the more potentially malignant clear cell carcinomas that account for 54% of the lesions resected, but 90% of those that metastasize. Due to a contemporary stage migration, 70% of the tumors are detected incidentally with a median tumor size of below 4.0 cm. Partial nephrectomy for tumors of 7 cm or less provides equivalent oncological tumor control to radical nephrectomy with maximum preservation of long-term renal function. Twenty-six percent of patients prior to operation already have stage 3 chronic kidney disease with an estimated glomerular filtration rate of less than 60 ml/min/1.73 m. Chronic kidney disease is an independent risk factor for the development of cardiovascular disease, hospitalization and death. The likelihood of freedom from a glomerular filtration rate of less than 45 was 95% after partial nephrectomy, but only 64% following radical nephrectomy. SUMMARY: Partial nephrectomy is an essential surgical approach to the small kidney tumor and provides equivalent local tumor control while preventing the new onset or worsening of chronic kidney disease.