Current status of open partial nephrectomy

Abstract

To assess the current status of open partial nephrectomy (OPN) for the treatment of renal tumors. Today, the standard indications for open nephron-sparing surgery are renal tumors in solitary kidneys, bilateral renal masses, tumors in patients with impaired renal function and unilateral masses smaller than 4 cm in diameter with a normal functioning contralateral kidney. For the latter, OPN is increasingly being challenged by laparoscopic partial nephrectomy, which in the hands of experts appears to achieve comparable oncological results, although at a higher complication rate. In selected situations, OPN appears justified in intermediate-risk patients with tumors up to 7 cm in diameter. Long-term outcome data indicate that OPN has cancer-free survival rates comparable to those of radical surgery with better preservation of renal function, decreased overall mortality and reduced frequency of cardiovascular events. OPN remains the standard of care for small renal masses and is increasingly advocated in selected patients with tumors up to 7 cm in diameter.