To analyse the current evidence of efficacy and safety of nephron-sparing surgery (NSS) that encompasses open partial
nephrectomy (OPN), laparoscopic partial
nephrectomy (LPN) and robotic partial
nephrectomy in the management of localized
renal cell carcinoma (RCC). Oncological data, complications and postoperative renal function were reviewed for the most important series of partial
nephrectomy. Partial
nephrectomy (PN) provides similar oncological control as radical
nephrectomy (RN) and is superior to RN with respect to preserving renal function and preventing
chronic kidney disease. OPN remains the first treatment option for T1 renal
tumors in centers without advanced laparoscopic expertise. Indications for LPN have expanded as such that LPN is suited for most renal
tumors provided that the procedure is carried out in selected patients by an experienced laparoscopic surgeon.
Warm ischemia time should be kept within 20 min, which is currently recommended regardless of surgical approach. In experienced hands, LPN yields intermediate oncological efficacy and renal function outcome comparable to open surgery in the treatment of pT1 renal
tumors.
Positive surgical margin rates are comparable after LPN and OPN. In contemporary series, the morbidity of LPN is decreasing to become similar to that of OPN. Preliminary results with robotic PN are comparable to results obtained with LPN. Additional studies are required to validate these results and compare with other current methods, such as thermal ablation. NSS is effective and safe for the management of localized RCC and is the gold standard to which new ablative techniques need to be compared.