Abstract
This paper has been presented with the goal of encouraging urologists that, even in the face of more locally advanced or high-grade disease, partial nephrectomy (PN) in select patients can provide oncological results comparable with radical nephrectomy (RN). As presented in the editorial comment, it appears that PN is oncologically equivalent to RN in renal tumors up to 7 cm in size, and recent studies suggest that this may even be extended to T2 tumors. 1 Karellas M.E. O'Brien M.F. Jang T.L. et al. Partial nephrectomy for selected renal cortical tumours of ≥ 7cm. BJU Int. 2010; 106: 1484-1487 Crossref PubMed Scopus (58) Google Scholar , 2 Breau R.H. Crispen P.L. Jimenez R.E. et al. Outcome of stage T2 or greater renal cell cancer treated with partial nephrectomy. J Urol. 2010; 183: 903-908 Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar In the authors' opinion, size should not impact the decision to perform PN if the surgeon feels it is technically feasible with meaningful renal parenchyma spared. 3 Lane B.R. Fergany A.F. Linehan W.M. et al. Should preservable parenchyma, and not tumor size, be the main determinant of the feasibility of partial nephrectomy?. Urology. 2010; 76: 608-609 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Patient survival has been shown to be superior in patients undergoing PN vs RN, 4 Weight C.J. Larson B.T. Gao T. et al. Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival. Urology. 2010; 76: 631-637 Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar presumably related to improved postoperative renal function, and should provide the major impetus for performing PN whenever possible. Unnecessary RN is still performed for a significant number of patients, particularly in the elderly, as well as in lower-volume centers. The rationale of a laparoscopic RN as a less invasive alternative to an open PN is attractive to both patients and surgeons, and perpetuates the practice of unnecessary RN for smaller tumors. Future progress will depend on increasing awareness of the risks of renal insufficiency, as well as increasing implementation of newer minimally invasive techniques and robotics, facilitating nephron-sparing surgery for a wider range of patients. Editorial CommentUrologyVol. 77Issue 5Preview“Compared to radical nephrectomy partial nephrectomy does not appear to compromise the chance for cancer cure in patients with clinical T1 tumors that are upstaged pathologically to pT2 or pT3.” This is the conclusion of this interesting paper. Full-Text PDF
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