The open surgical treatment of renal cell carcinoma has undergone critical review over the past decade. Initially treated with radical nephrectomy, renal cell carcinoma is now more often approached with nephron-sparing surgical techniques. Because of the widespread availability of non-invasive imaging tests such as renal ultrasound and CT scan, many renal cell carcinomas are now being found incidentally. With the increasing number of incidentally detected kidney tumors, a size and stage migration has occurred in renal cell carcinoma. The absolute indications for partial nephrectomy involve circumstances in which the patient is at risk for renal failure if radical nephrectomy were to be performed. Early studies showed that disease-free survival rates were similar between cancers treated with radical and partial nephrectomy. The tendency now is to offer partial nephrectomy as a surgical option to patients with renal lesions measuring 4.0cm or smaller even in the presence of a normal contralateral kidney. A follow-up at regular intervals is recommended because certain recurrences may indicate second surgery. A rise in incidence, improved diagnostic procedures and evolving therapeutic possibilities emphasise the importance of open surgical treatment of localised renal cell carcinoma.