title: Important aspects of organ-preserving surgery for renal tumors: indications, new standards, and oncological outcomes.
abstract: BACKGROUND
  Organ-preserving surgery for renal tumors has become more common over the past two decades. At first, part of the kidney, rather than all of it, was resected only if there was an absolute indication for doing so, i.e., if the tumor was located in an anatomically or functionally solitary kidney or if renal failure was already present. Now that favorable oncological outcomes have been demonstrated, renal tumors are increasingly often removed with only partial resection of renal tissue even when the indications are less stringent, including when the other kidney is healthy.
  
  
  METHODS
  The indications for, and oncological outcomes of, partial renal resection are presented and discussed on the basis of a selective literature search of Medline as well as the guidelines of the European Association of Urologists (EAU).
  
  
  CONCLUSIONS
  The EAU, in its new guidelines for renal cell carcinoma, recommends partial renal resection as the standard treatment for tumors less than 4 cm in size that are wholly contained within one kidney when the other kidney is healthy. This practice yields comparable outcomes to those of nephrectomy, with tumor-specific five-year survival rates exceeding 90%. In major urological centers, partial resection is favored even for tumors larger than 4 cm, as long as they are in a favorable location. Nonetheless, the estimated rate of nephrectomy for tumors less than 4 cm in size currently remains very high in Germany, as it does in American studies, even though the organ-preserving resection of such small tumors usually results in cure.
authors: Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. frank.becker@uks.eu
authors: Frank
authors: F
authors: Becker
authors: Stefan
authors: S
authors: Siemer
authors: Jörn
authors: J
authors: Kamradt
authors: Ulrike
authors: U
authors: Zwergel
authors: Michael
authors: M
authors: Stöckle
mesh_terms: D005858:Germany; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000592:standards / Q000639:trends*; D009392:Nephrectomy / Q000379:methods* / Q000592:standards / Q000639:trends*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome