The Expanding Role of Partial Nephrectomy: A Critical Analysis of Indications, Results, and Complications

Karim Touijer, Didier Jacqmin, Louis R. Kavoussi, Francesco Montorsi, Jean Jacques Patard, Craig G. Rogers, Paul Russo, Robert G. Uzzo, Hendrik Van Poppel

Research output: Contribution to journalArticle

Abstract

Context: The gained expertise in the surgical technique of partial nephrectomy (PN) with excellent oncologic outcome and reduced morbidity has contributed to more frequent use of PN in many centres of reference, and the recent evidence favouring PN over radical nephrectomy (RN) in the prevention of chronic kidney disease and possibly linking it to a better overall survival (OS) will constitute a strong argument for wider use of PN. Objective: To objectively analyse the advantages of PN over RN and to evaluate the risk-benefit ratio of expanding the indications of PN T1b renal cortical tumours. Evidence acquisition: Literature searches on English-language publications were performed using the National Library of Medicine database. The queries included the keywords partial nephrectomy and nephron sparing surgery. Eight hundred four references were scrutinised, and 175 publications were identified and reviewed. Sixty-nine articles were selected for this review. These references formed the basis for this analysis and were selected based on their relevance and the importance of their content. Evidence synthesis: The use of PN has been steadily increasing, particularly in tertiary care centres. This trend is now strengthened by evidence supporting the role of PN in reducing the risk of chronic kidney disease in patients with renal masses ≤4 cm. A wider use of PN for larger tumours, granted technical feasibility, is supported by the preliminary evidence, suggesting an OS advantage favouring PN over RN. However, the potential for selection bias and residual confounding factors may contribute to the observed difference. In the carefully selected patients with tumours >4 cm, PN obtained equivalent oncologic outcome to that achieved after RN. Although higher morbidity rates were seen after PN, the complication type and severity were not prohibitive. Conclusions: The available evidence supports elective PN as the standard surgical treatment for renal cortical tumours ≤4 cm. For larger tumours, PN has demonstrated feasibility and oncologic safety in the carefully selected patient population studied.

Original languageEnglish
Pages (from-to)214-222
Number of pages9
JournalEuropean Urology
Volume57
Issue number2
DOIs
Publication statusPublished - Feb 2010

Keywords

  • Nephron-sparing surgery
  • Partial nephrectomy
  • Renal cell carcinoma
  • Renal tumours

ASJC Scopus subject areas

  • Urology

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    Touijer, K., Jacqmin, D., Kavoussi, L. R., Montorsi, F., Patard, J. J., Rogers, C. G., Russo, P., Uzzo, R. G., & Van Poppel, H. (2010). The Expanding Role of Partial Nephrectomy: A Critical Analysis of Indications, Results, and Complications. European Urology, 57(2), 214-222. https://doi.org/10.1016/j.eururo.2009.10.019