Minimally invasive nephron-sparing surgery

Abstract

To review the evolution and current status of minimally invasive nephron-sparing surgery for renal tumors. Minimally invasive nephron-sparing surgery for renal tumors encompasses extirpative laparoscopic partial nephrectomy and ablative procedures such as cryoablation, radiofrequency ablation, and recently radiosurgery. Minimally invasive nephron-sparing surgery modalities are associated with decreased morbidity when compared with open partial nephrectomy. Recent multicenter study comparing laparoscopic partial nephrectomy and open partial nephrectomy demonstrated that equivalent cancer-specific survival was similar between the two modalities. Encouraging long-term data are available for laparoscopic partial nephrectomy and cryoablation. However, some concerns remain about incomplete tumor cell kill after radiofrequency ablation. Radiosurgery is a promising new technology, but is still experimental. In 2008, open partial nephrectomy and laparoscopic partial nephrectomy are the reference standards for treating the small renal mass, with laparoscopic partial nephrectomy increasingly becoming the preferred option at major tertiary referral centers. Encouraging long-term data for ablative technologies are emerging.