title: Treatment outcomes of partial nephrectomy for T1b tumours.
abstract: OBJECTIVE
  Nephron-sparing surgery is the standard of care for the treatment of localized renal tumours and is increasingly performed for larger and more challenging lesions. Aim of this review is to analyse the outcomes of partial nephrectomy for the treatment of T1b renal tumours greater than 4 cm in size.
  
  
  RESULTS
  No randomized trial has compared the outcomes of partial nephrectomy compared to radical nephrectomy for T1b renal tumours. However, several single, multi-institutional and population-based studies consistently showed similar cancer-specific survival rates for open partial nephrectomy (OPN) and radical nephrectomy for tumours greater than 4 cm in size. A decreased loss in renal function was observed with partial nephrectomy compared to radical nephrectomy for T1b tumours. Laparoscopic partial nephrectomy (LPN) for tumours greater than 4 cm in size was shown to obtain similar short-to-intermediate-term oncological outcomes of laparoscopic radical nephrectomy and OPN in experienced centres, but is associated with longer warm ischaemia time and higher complication rates. The initial series of robot-assisted partial nephrectomy show similar perioperative results and decreased warm ischaemia time compared to LPN, whereas the oncological outcomes are still immature.
  
  
  CONCLUSIONS
  Partial nephrectomy for T1b renal tumours achieves comparable oncological outcomes and better preservation of renal function compared to radical nephrectomy and should be performed whenever technically possible. OPN remains at present the gold standard technique. LPN represents an alternative to OPN in centres with advanced laparoscopic expertise. Robot-assisted partial nephrectomy has the potential to overcome the drawbacks of pure laparoscopic surgery, but larger series and longer follow-up are needed to further define its role in the management of T1b tumours.
authors.affiliation: Division of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy. alessandro.volpe@med.unipmn.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.forename: Daniele
authors.initials: D
authors.lastname: Amparore
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D047368:Tumor Burden; D052096:Warm Ischemia