Management of Small Renal Masses: Nephron Sparing Surgery

, Younsoo Jeon

Review Article

The Korean Journal of Urological Oncology 2010;8(3):115-121.
Published online December 1, 2010.

소신종물의 치료: 신원보존수술

전 윤 수

순천향대학교 의과대학 비뇨기과학교실

Management of Small Renal Masses: Nephron Sparing Surgery

Younsoo Jeon

Department of Urology, School of Medicine, Soonchunhyang University, Cheonan, Korea

Correspondence: Younsoo Jeon

Abstract

The incidence of small renal mass is increasing due to prevalent cross sectional imaging. A contemporary review of the indications, techniques, and outcomes is presented for nephron sparing surgeries (NSS) to small renal masses. Clinical literatures for nephron sparing surgery to small renal mass were reviewed. Open and laparoscopic NSS were evaluated and analysed in terms of indication, techniques, and clinical and oncological outcomes. The long-term data regarding open NSS have demonstrated equal oncological outcomes compared to radical nephrectomy. The indications for the maximal preservation of renal parenchyma have been expanded to patients with small, localized, often incidental tumors and a normal contralateral kidney. Laparoscopic approaches to NSS have shown similarly favorable clinical results. Functional and oncological outcomes were not different in open and laparoscopic NSS for renal cell carcinoma. However, laparoscopic NSS had a longer ischemic time and higher perioperative complication rates. NSS is a standard of care for patient with small renal mass under not only imperative but also elective indication. Although oncological and functional outcomes of laparoscopic NSS are acceptable when compared to those of open NSS, which has a longer warm ischemic time and higher perioperative morbidity. Laparoscopic NSS should be considered for select case such as peripheral, exophytic and small renal mass and also in experienced hand. (Korean J Urol Oncol 2010;8:115-121)

Key Words: Kidney, Renal cell carcinoma, Nephron sparing surgery, Nephrectomy