Current surgical aspects of renal cell carcinoma

Surgery of renal cell carcinoma (RCC) has undergone substantial changes during the past years. Until the 1990s, radical nephrectomy together with ipsilateral adrenalectomy was considered the golden standard. Meanwhile it was demonstrated that tumours up to 4 cm in diameter and a normal contralateral kidney can be treated by partial nephrectomy (elective indication) without compromising oncological safety. Development of laparoscopy influenced renal surgery significantly. Currently, laparoscopic nephrectomy is considered a golden standard for renal masses larger than 4 cm (T1b-T2), whereas open radical nephrectomy is reserved for large, locally advanced tumours, caval extension or enlarged lymph nodes. Adrenalectomy can be omitted if the adrenal appears normal. Tumours less than 4 cm should undergo partial nephrectomy. The better renal functional reserve after elective partial compared with radical nephrectomy seems to be associated with better overall survival. For partial nephrectomy the open approach currently remains the golden standard, whereas laparoscopy is reserved for specialized centres.