Open partial nephrectomy. Personal technique and current outcomes.
Review
Overview
abstract
Modern imaging capabilities has created a renal tumor stage and size migration with approximately 70% of patients today detected incidentally with a median tumor size of 4cm or less. In addition, our current understanding indicates that renal cortical tumors are a family of neoplasms with distinct histopathological and cytogenetic features and variable metastatic potential.The conventional clear cell tumor has a malignant potential and accounts for only 54% of the total renal cortical tumors but 90% of those that metastasize. Radical nephrectomy, whether performed by open or minimally invasive surgical technique, plays an important role in the management of massive renal tumors that have replaced the normal renal parenchyma, invade the the renal vein, and have associated regional lymphadenopathy or metastatic disease. Partial nephrectomy has emerged as the treatment of choice for patients with smaller tumors. This operation can be performed through a "miniflank" surgical incision without rib resection. Complications related to partial nephrectomy, including bleeding, urinary fistula and infection occur in less than 10% of cases. Radical nephrectomy should not be performed for the treatment of small renal tumors since it is associated with the causation or worsening of preexisting CKD which can cause an increased likelihood of cardiovascular morbidity and mortality. Despite a wealth of evidence supporting the more restricted indications for RN, strong evidence exists that it remains over utilized in the United States. Widespread education and training in kidney preserving surgical strategies is essential going forward.
