Surgical Resection of Malignant Tumors of the Kidney:
The primary treatment for malignant tumors of the kidney (renal cell carcinoma - RCC) is surgical removal (1-6). The degree of surgery may be tailored to the extent of disease, and varies from removal of only the diseased part of the kidney (partial nephrectomy), to removal of the entire kidney (total nephrectomy), to removal of the entire kidney and adjacent tissues such as lymph nodes (extended total nephrectomy), to removal of tumor deposits that have spread elsewhere in the body (metastectomy). All of these approaches up to and including metastectomy have curative potential in selected RCC patients, though the chance of extended survival is significantly diminished in the presence of lymph node or distant metastases (1-6). Because long-term survivors are seen at all stages of RCC, aggressive treatment of primary, regional and limited metastatic disease has been advocated (2,6).
Small primary RCC lesions appear effectively treated with partial nephrectomy (removal of only the diseased part of the kidney), which produces apparently identical long-term disease-free survival compared with total nephrectomy (removal of the entire kidney), with long-term disease-free survival exceeding 90% in some series (1,3,4,5). There appears to be a trend to partial nephrectomy approaches over time (5), with one study advocating partial nephrectomy as the “standard of care,” in patients with small lesions (4).
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