Partial Nephrectomy: A Contemporary Review Regarding Outcomes and Different Techniques

摘要

Open partial nephrectomy is evolving as the standard of care for treatment of all amendable renal masses with laparoscopic and robotic assisted surgery being reported with increasing frequency. We reviewed the literature to assess the current state of knowledge regarding various outcomes with open, laparoscopic, and robotically assisted partial nephrectomy. Many studies report excellent long-term functional and oncological outcomes when evaluating open partial nephrectomy for both imperative and elective reasons. Preservation of renal function as compared with radical nephrectomy seems to be major benefit. With limited data and follow-up, laparoscopic partial nephrectomy is an evolving technique with oncological outcomes, in experienced hands, similar to those seen in large open partial nephrectomy series. However, laparoscopic partial nephrectomy seems to be associated with longer ischemia times, increased reoperative rates, and complication rates. Robotic nephrectomy is technically feasible but the overall virtues of such an approach remain to be determined. Concerns over preservation of renal function with any approach are paramount with continued efforts to limit warm ischemia without compromising oncological efficacy.