Editorial Comment

Abstract

Over the last 20 years, our understanding of renal cortical tumors (RCT) and their best management has evolved. Formerly, surgeons felt that tumors of all sizes and locations were best managed by radical nephrectomy (RN) if there was a functional contra lateral kidney. Partial nephrectomy (PN), initially used sparingly, was reserved for essential indications such as tumor in a solitary kidney, tumor in a patient with renal calculus disease or renal insufficiency, and for patients with bilateral renal tumors. Now we understand that RCT are a complex family of tumors with at least 31 separate subtypes described based on genomic and metabolomic studies. 1 Chen F. Zhang Y. Şenbabaoğlu Y. et al. Multilevel genomics-based taxonomy of renal cell carcinoma. Cell Rep. 2016; 14 (Epub 2016 Mar 3): 2476-2489https://doi.org/10.1016/j.celrep.2016.02.024 Abstract Full Text Full Text PDF PubMed Scopus (245) Google Scholar , 2 Hakimi A.A. Reznik E. Lee C.H. et al. An integrated metabolic atlas of clear cell renal cell carcinoma. Cancer Cell. 2016; 29: 104-116https://doi.org/10.1016/j.ccell.2015.12.004 Abstract Full Text Full Text PDF PubMed Scopus (391) Google Scholar These tumors pose a spectrum of oncologic threats ranging from benign (20%), indolent with limited metastatic potential (25%), and malignant (55%). This variable threat from RCT coupled with the understanding that PN provides equivalent tumor control to RN while at the same time preserving renal function, preventing, or delaying chronic kidney disease and its associated cardiovascular disease lead to enhanced utilization of PN in the elective setting. 3 Russo P. Oncological and renal medical importance of kidney-sparing surgery. Nat Rev Urol. 2013; 10: 292-299 Crossref PubMed Scopus (25) Google Scholar