Outcomes of partial nephrectomy for clinical T1b and T2 renal tumors

Purpose of review: To review current status of partial nephrectomy for treatment of T1b and T2 renal mass, focusing oncological and renal functional outcomes reported in the last 18 months, and to understand the emerging role of minimally invasive surgery (MIS) techniques in nephron-sparing management of T1b/T2 tumors. Recent findings: With recent long-term oncological equivalence to radical nephrectomy and renal functional benefit, partial nephrectomy is becoming an alternate standard to radical nephrectomy in the management of T1b tumors. The role of partial nephrectomy in nonelective treatment of T2 tumors is more controversial; however, recent publication of two large North American series have added to other contemporary work that suggests oncologic equivalence and renal functional benefit compared to radical nephrectomy in select patients. Emerging data demonstrate feasibility of MIS for increasing the proportion of T1b/T2 tumors; however, recent trends analyses demonstrate that the majority of T1b/T2 partial nephrectomy are still carried out by open surgery, and concerns continue about prolonged ischemic times and risk of bleeding in various MIS settings. Summary: Management of T1b and T2 renal masses is transforming with adoption of partial nephrectomy as a safe and feasible surgical option with comparable oncological and improved renal function outcomes compared to radical nephrectomy. MIS techniques play an expanding, though still limited, role, and more robust prospective data is requisite before drawing overarching conclusions.