New aspects in the treatment of localized renal cell carcinoma
Abstract
BACKGROUND: Localized renal cell carcinoma is increasingly relevant in daily urological practice due to earlier diagnosis and higher life expectancy.
OBJECTIVES: To analyze and compare current treatment evidence for localized renal cell carcinoma regarding new aspects of nephron-sparing surgery, the different surgical approaches and focal therapy.
METHODS: A systematic search was performed to identify relevant publications from 2018 and 2019.
RESULTS: Prospective randomized trials comparing nephrectomy with partial nephrectomy, the three different surgical approaches with each other, and focal therapy with surgery are still lacking. Positive effects on survival by partial nephrectomy could be demonstrated, even though partial nephrectomy has a higher morbidity than radical nephrectomy. Older patients (>75 years) with advanced localized renal cell carcinoma did not appear to benefit from partial nephrectomy so far, but minimally invasive surgical approaches are underrepresented in such studies. Minimally invasive partial nephrectomy is superior to the open approach, and robot-assisted partial nephrectomy has better results than laparoscopy. Focal therapy of kidney tumors is technically safe and feasible, but relevant comparisons with partial nephrectomy are still lacking.
CONCLUSIONS: Partial nephrectomy is still the gold standard treatment for localized renal cell carcinoma, it should be preferably performed by a robot-assisted approach. Focal therapy can serve as an…
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