European urology supplements vol:3 issue:3 pages:9-13
Recent trends in cancer surgery have shown that the same cure rates can be achieved with more organ and tissue sparing techniques and multimodal approaches. Developments in technology and better patient care now render most operations to be possible.
In the past radical nephrectomy for renal cell carcinoma (RCC) used to save many lives because most of the patients were presenting at advanced stages. Thanks to modern imaging techniques and health awareness of the public, today, most of the patients are presenting with small incidentally detected renal masses. Apart from patients requiring organ preservation for absolute and relative indications, most patients today are enjoying the benefits of nephron sparing surgery (NSS) in an elective setting.
The crucial step in NSS is to get control of the renal vessels first and to expose the whole kidney to look for satellite cortical lesions. A safe rim of healthy tissue has to be removed together with the tumor. All bleeders are sutured, and if the collecting system is entered, it should be repaired. The parenchyma is sutured for approximation with absorbable sutures.
The long term results with NSS show acceptable oncological outcome. The rate of complications of NSS has dramatically decreased with better patient selection, improved techniques and better management. All patients should be informed of the complications, recurrence rates and follow-up conditions.
The advances in laparoscopic techniques now render NSS possible in selected patients. However, this is an extremely challenging operation, and can only be performed in expert hands. New technology is also emerging utilizing new forms of energy for tumor destruction and ultimately for nephron sparing approaches in localized RCC. As we are detecting more small renal masses, some of which are benign, NSS will remain to be the treatment of choice for these patients.