Should elective partial nephrectomy be performed for renal cell carcinoma >4 cm in size?

This Practice Point discusses the study of Pahernik and colleagues, which compared outcomes of partial nephrectomy between 102 patients with renal cell carcinoma >4 cm in size and 372 patients with tumors <or=4 cm in size. No significant differences were seen between the two groups in local-recurrence-free survival and cancer-specific survival at 10 years. This study adds to the growing literature base supporting partial nephrectomy for small renal masses whenever possible. The rationale for further expanding the indications for partial nephrectomy includes the presence of indolent or benign tumor histology in 45% of patients, concerns that radical nephrectomy can cause or worsen pre-existing chronic kidney disease, and the possibility of metachronous contralateral tumor recurrence in a solitary kidney after radical nephrectomy. Although technically more demanding than radical nephrectomy, partial nephrectomy provides equivalent oncological control while preserving renal function and preventing chronic kidney disease, and should be utilized whenever possible for the treatment of small renal masses.