The evolving role of partial nephrectomy in the management of renal cell carcinoma.
The surgical management of renal cell carcinoma has undergone critical review over the past decade. Initially treated with radical nephrectomy, renal cell carcinoma is now approached with nephron-sparing surgical techniques. Improved imaging modalities have substantially increased the number of incidental renal tumors detected, and with the increasing number of incidentally detected kidney tumors, a size and stage migration has occurred in renal cell carcinoma. Early studies showed that disease-free survival rates were similar between cancers treated with radical and partial nephrectomy. The standard now is to offer partial nephrectomy as a surgical option to all patients with renal lesions measuring 4.0 cm or smaller in the setting of a normal contralateral kidney. More recent issues regarding partial nephrectomy concern complication rates and management, renal cell carcinoma multifocality, margin status and distance to normal renal parenchyma, cost analysis, and the development of laparoscopic techniques that duplicate open partial nephrectomy. The purpose of this review is to outline and analyze these more recent concerns regarding partial nephrectomy.
Gilbert
Scott M
SM
Department of Urology, Columbia-Presbyterian Medical Center, 161 Fort Washington Avenue, Atchley Pavilion, 11th floor, New York, NY 10032, USA.
Russo
Paul
P
Benson
Mitchell C
MC
Olsson
Carl A
CA
McKiernan
James M
JM
D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003362:Cost-Benefit Analysis / Q000191:economics; D019468:Disease Management; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000191:economics; D014481:United States / Q000453:epidemiology