Risk reduction in kidney surgery

Partial nephrectomy has become a cornerstone of kidney cancer surgery. Several studies have shown at least equivalent oncologic results of partial and radical nephrectomy (1,2). The preservation of functioning kidney parenchyma is thought to reduce the risk of developing comorbidities such as chronic kidney failure, thereby potentially improving survival (3-6). The only randomized controlled trial comparing radical and partial nephrectomy showed equivalence of both procedures (7). Besides elective indications, several situations may require nephron sparing surgery in an imperative indication, where radical nephrectomy would subject the patient to hemodialysis, suffering from immunosuppressive side effects and experiencing reduced overall survival.