Partial nephrectomy achieves local tumor control and prevents chronic kidney disease.
Over the last 10 years, a rapidly changing clinical landscape has created an optimal environment to expand the use of partial nephrectomy for the treatment of renal cortical tumors. The main factors responsible for the increasing use of partial nephrectomy relate to the appreciation of the diversity of renal cortical tumor histology, the tumor stage and size migration associated with their incidental detection, and the oncological efficacy of partial nephrectomy for tumors of 7 cm or smaller. Evidence has now emerged that radical nephrectomy performed during the treatment of a small renal mass may further reduce an already impaired baseline renal function and place the patient in the realm of chronic kidney disease. Important new information concerning chronic kidney disease, a condition far more prevalent in the aging US population than previously appreciated, and its associated cardiovascular morbidity and mortality, now places maximal renal functional preservation on a par with local tumor control as surgical plans are formulated for the resection of a small renal cortical tumor.
Russo
Paul
P
Memorial Sloan-Kettering Cancer Center, Department of Surgery, Urology Service, 1275 York Avenue, NY, 10021, USA. russop@MSKCC.org
D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery; D018249:Adenoma, Oxyphilic / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002908:Chronic Disease; D006801:Humans; D007672:Kidney Cortex / Q000601:surgery; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D016030:Kidney Transplantation; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D014019:Tissue Donors; D016896:Treatment Outcome