Surgical management of the localized renal mass: risk and benefit trade-offs and surgical approach considerations

Abstract

: The incidence of renal masses has increased over recent years, with a shift towards diagnosis at earlier stages. Surgical resection remains the mainstay of treatment for localized renal masses. While radical nephrectomy (RN) once dominated as the approach of choice, partial nephrectomy (PN) and other nephron-sparing techniques have recently gained prominence. Although PN boasts improved outcomes in regard to preserving renal function, the perioperative risks remain greater than those of RN, and potential survival benefits continue to be debated. Advances continue to be made in identifying which carefully-selected patients may benefit significantly from PN as compared to RN. The advent of the robotic surgical platform has introduced additional options to consider when making treatment decisions. The robotic approach has been associated with superior outcomes in PN. For RN, the robotic platform has thus far been associated with increased costs and operative time, without improved outcomes. Tumor enucleation (TE) has gained popularity as a method to preserve additional renal parenchyma, but remains controversial. This article reviews the risks, benefits, and outcomes of approaches to radical and PN in order to best inform the modern urologic surgeon in making treatment decisions.