Partial nephrectomy(very good).doc

Partial nephrectomy: the standard approach for small renal cell carcinoma? Poppel, Hein VanDepartment of Urology, University Hospital Gasthuisberg, B-3000 Leuven, BelgiumCorrespondence to Professor Dr Hein Van Poppel, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium Tel: +32 16 34 66 87; fax: +32 15 34 69 31; e-mail: hendrik.vanpoppel@uz.kuleuven.ac.be Since the first partial nephrectomy for renal cell carcinoma was performed in 1887 by Czerny [1], the interest in nephron-sparing techniques has greatly increased during the past few decades as a result of advances in renal imaging, an increasing number of Incidentally detected low-stage tumours, and the growing experience with renovascular surgery. Whereas the surgical management of renal cell carcinoma first has to cure the patient, the kidney functional status of the patient has become a more important consideration in recent years. Besides the absolute indications for partial nephrectomy, in which radical nephrectomy makes the patient a candidate for haemodialysis or kidney transplantation, the relative indications for partial nephrectomy have extended from cases with calculous disease, infectious processes, vascular problems, hypertension, etc., to the so-called elective indications in patients with small localized tumours and a normal contralateral kidney. Many major urological centres [2-7] have reported on elective kidney-sparing surgery in a substantial number of patients with comparable cancer-specific survival and disease-free survival rates to those obtained with radical nephrectomy. On the basis of these results, and although radical nephrectomy has been the standard of care for every suspected renal cell carcinoma for over half a century, partial nephrectomy is now being applied in more and more centres, not only by an open surgical approach but more recently also by laparoscopy [8]. No randomized study has yet shown the oncological equivalence of partial and radical nephre