title: Open partial nephrectomy. Personal technique and current outcomes.
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.
authors.affiliation: Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA. RussoP@MSKCC.org
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
mesh_terms: D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D007511:Ischemia / Q000209:etiology; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D009392:Nephrectomy / Q000266:history / Q000379:methods* / Q000706:statistics & numerical data; D010347:Patient Care Planning; D012079:Renal Circulation