Partial Nephrectomy Guidelines

Updated: Jun 08, 2022
  • Author: Reza Ghavamian, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines Summary

Management of stage I renal mass

In patients who have a clinical T1a renal mass for which intervention is indicated, the American Urological Association (AUA) guideline recommends prioritizing partial nephrectomy, because it minimizes the risk of chronic kidney disease (CKD) or CKD progression and is associated with favorable oncologic outcomes, including excellent local control (Moderate Recommendation; Evidence Level: Grade B). [24]

For a pathologic T1a renal mass, National Comprehensive Cancer Network (NCCN) lists the following as treatment options [25] :

  • Partial nephrectomy (preferred)
  • Radical nephrectomy (if partial not feasible or central location)
  • Active surveillance in selected patients
  • Ablative techniques in selected patients

For pT1b disease, the NCCN recommends either partial or radical nephrectomy. [25]

The 2019 European Society for Medical Oncology (ESMO) guidelines also recommend partial nephrectomy as the preferred option in tumors measuring up to 7 cm. Partial nephrectomy is also recommended in patients with compromised renal function, solitary kidney, or bilateral tumors, with no tumor size limitation. [26]

Management of clinical stage II and III renal masses

For stage II renal tumors, the NCCN guideline recommends partial nephrectomy or radical nephrectomy as primary treatment. For stage III, the NCCN guideline recommends radical nephrectomy, or partial nephrectomy if clinically indicated. Examples of cases in which partial nephrectomy is appropriate include the following [25] :

  • Unilateral stage I-III tumors where technically feasible
  • Uninephric state
  • Renal insufficiency
  • Bilateral renal masses
  • Familial RCC
  • Patients at relative risk for developing progressive chronic kidney disease due to young age or medical risk factors (ie, hypertension, diabetes, nephrolithiasis)