Abstract
The increased number of small renal masses (SRMs) detected annually has led to a rise in the use of nephron-sparing surgery (NSS). These techniques aim to preserve the largest amount of healthy renal tissue possible while maintaining the same oncologic outcomes as radical nephrectomy (RN). Additionally, partial nephrectomy (PN) has been linked to a lower risk of chronic kidney disease, cardiovascular morbidity, and mortality when compared to RN. There has been continual progress toward resecting less renal parenchyma. While the predominant surgical method of performing NSS is through traditional PN, simple enucleation (SE) of the tumor has increased in popularity over recent years. SE is a technique that aims to preserve the maximal amount of renal parenchyma possible by utilizing the renal tumor pseudocapsule to bluntly separate the lesion from its underlying parenchyma, offering the smallest possible margin of excised healthy renal tissue. Several studies have demonstrated the oncological safety of SE compared with PN in the treatment of SRMs, with lower overall incidence of positive surgical margins. Additionally, SE has been shown to have similar 5- and 10-year progression-free and cancer-specific survival as PN. We present a review of the literature and an argument for SE to be a routine consideration in the treatment of all renal tumors amenable to NSS.
Highlights
It is estimated that there will be 61,560 new cases of kidney cancer in the United States in 2015, and an estimated 14,080 deaths [1]
One study found a baseline chronic kidney disease (CKD) in 22% of patients presenting for surgical management of their renal tumors, with this incidence increasing to 40% in patients aged 70 years [15]
While the predominant surgical method of performing nephron-sparing surgery (NSS) is through traditional partial nephrectomy (PN), simple enucleation (SE) of the tumor has increased in popularity over recent years [18,19,20,21]
Summary
It is estimated that there will be 61,560 new cases of kidney cancer in the United States in 2015, and an estimated 14,080 deaths [1]. One study found a baseline CKD (stage III or greater) in 22% of patients presenting for surgical management of their renal tumors, with this incidence increasing to 40% in patients aged 70 years [15] For these reasons, current guidelines support the use of NSS for the treatment of the SRM whenever technically feasible [6,16]. Minervini et al have published multiple times on the role of pseudocapsule penetration on rates of PSM and oncological outcomes [26,27] In their most recent analysis of patients undergoing SE, 51% of specimens had an intact pseudocapsule free from neoplastic invasion, 35% had capsular penetration on the parenchymal side, and 14% had invasion into the perirenal adipose tissue (left attached to surface of tumor). Fiveand 10-year CSS rates were 94% and 94% for SE and 92% and 89% for RN, respectively (p=“non-significant”)
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