title: Oncological outcomes of partial nephrectomy for renal carcinoma greater than 4 cm.
abstract: OBJECTIVE
  To provide the clinical evidence and benefits of performing partial nephrectomy for renal tumors greater than 4 cm.
  
  
  RESULTS
  Partial nephrectomy was historically performed only for the essential indications of a tumor in a functional or anatomical solitary kidney or in the face of bilateral renal tumors. Partial nephrectomy has now emerged as an oncologically equivalent operation to radical nephrectomy for T1a tumors (<4 cm) with the added benefit of renal functional preservation which can prevent or delay the onset of chronic kidney disease (CKD). CKD is an independent risk factor for hospitalization events, cardiovascular disease, and worse overall survival. Recent evidence has demonstrated that partial nephrectomy also provides equivalent oncological results for larger renal tumors including those of 4-7 cm and even for greater than 7 cm, whenever technically feasible with the continued added benefit of renal functional preservation. Partial nephrectomy is effectively performed using both open surgical techniques and increasingly by minimally invasive approaches although the latter is technically challenging.
  
  
  CONCLUSIONS
  Despite the mounting clinical evidence that partial nephrectomy is an effective and preferable approach to the T1 renal mass, it remains markedly underutilized in the USA and abroad. The overzealous use of radical nephrectomy for the T1 renal mass, by whatever surgical approach, must now be considered detrimental to the long-term health of the kidney tumor patient.
authors: Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA. RussoP@MSKCC.org
authors: Paul
authors: P
authors: Russo
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D007680:Kidney Neoplasms / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D016896:Treatment Outcome