Abstract
Surgery is a method of choice for the management of localized and locally-advanced renal tumors. In cT1a (up to 4 cm) tumors nephron-sparing approach (= partial nephrectomy) is current recommended standard, provided it is technically feasible and there are no contraindications.
The amount of nephron-sparing surgeries increases over time also owing to new technologies such as 3D imaging during surgery, robot-assisted surgery, better hemostatic instruments and greater experience, which all lead to shorter or no warm ischemia during nephron-sparing surgery. However, there is no long-term functional benefit in elderly patients over 75 years of age.
Nevertheless, if preservation of functional parenchyma is needed, thermal ablation methods (radiofrequency ablation or cryoablation) or active surveillance are possible. In management of locally advanced renal tumors R0 surgery is intended as adjuvant systemic treatment in not yet the standard.
For selected patients with distant metastases surgery, metastasectomy, is possible. However, only complete metastasectomy of all lesions brings better overall survival.