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Partial Nephrectomy

Historically, partial nephrectomy (PN) was performed under restricted, essential conditions for patients with a tumor in a solitary kidney, bilateral kidney tumors, or for patients with chronic renal insufficiency due to intrinsic renal dysfunction or calculus disease. Due to the increased use of cross sectional imaging for nonspecific musculoskeletal or abdominal complaints or during unrelated cancer care, approximately 70% of renal tumors are now detected incidentally at a small size Although the traditional radical nephrectomy (RN) was liberally used to resect these small tumors in patients with a normal contralateral kidney, the realization that at least 20% of these tumors were benign and 25% were indolent coupled with equivalent oncological outcomes whether RN or PN was performed, lead to the current era of kidney sparing or nephron sparing surgery. Recent data associating RN with the development of chronic kidney disease (CKD), cardiovascular morbidity, and worse overall survival when compared to PN have led to the recommendation by the 2009 American Urological Association Guidelines Committee that PN should be performed whenever technically feasible for the management of the T1 renal mass. Medical comorbidities especially affecting the cardiovascular system and kidney were investigated in detail. History of heavy cigarette smoking, hypertension, diabetes, and coronary artery disease was noted in detail, and a detail physical examination was performed preoperatively. These factors are known to contribute to perioperative complications and may also be etiological factors in the development of kidney cancer. Cardiac status was evaluated by performing echocardiogram, stress test, and carotid duplex studies. In addition, estimated glomerular filtration rate was calculated as it is well known that approximately 26% of patients undergoing PN have CKD which they were unaware.

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