Purpose of review: To assess the current status of open partial nephrectomy (OPN) for the treatment of renal tumors.
Recent findings: Today, the standard indications for open nephron-sparing surgery are renal tumors in solitary kidneys, bilateral renal masses, tumors in patients with impaired renal function and unilateral masses smaller than 4 cm in diameter with a normal functioning contralateral kidney. For the latter, OPN is increasingly being challenged by laparoscopic partial nephrectomy, which in the hands of experts appears to achieve comparable oncological results, although at a higher complication rate. In selected situations, OPN appears justified in intermediate-risk patients with tumors up to 7 cm in diameter. Long-term outcome data indicate that OPN has cancer-free survival rates comparable to those of radical surgery with better preservation of renal function, decreased overall mortality and reduced frequency of cardiovascular events.
Summary: OPN remains the standard of care for small renal masses and is increasingly advocated in selected patients with tumors up to 7 cm in diameter.