title: Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses.
abstract: While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN).
  
  
  
  To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature.
  
  
  
  A collaborative critical review of the medical literature was conducted.
  
  
  
  Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients.
  
  
  
  For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling.
  
  
  
  Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy.
authors.affiliation: University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Seidman Cancer Center, Urology Institute, Center of Healthcare Outcomes and Quality, Cleveland, OH, USA; Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT, USA.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Campbell
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Inderbir
authors.initials: I
authors.lastname: Gill
authors.affiliation: Spectrum Health Medical Group, Urology, Grand Rapids, MI, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.affiliation: Department of Urology, University Hospitals of Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Hein
authors.initials: H
authors.lastname: Van Poppel
authors.affiliation: Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.affiliation: Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA. Electronic address: alexander.kutikov@fccc.edu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
mesh_terms: D000066491:Clinical Decision-Making; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Partial nephrectomy; Radical nephrectomy; Renal cell carcinoma; Renal masses; Surgery