Mandatory testimony
For tumors larger than 7 cm, nephrectomy remains the standard, but if the second kidney is missing or damaged, resection becomes the only way to avoid dialysis. According to MSCT angiography, a resection line is planned while preserving the maximum parenchyma; Selective vascular clamping or cold ischemia is used, and the exposed collecting system is reconstructed on a stent. The risk of conversion to open surgery is 10-15%, complications - 10-20%, but renal function in most cases remains at an acceptable level. After the operation, follow-up by a nephrologist and oncourologist.
Why save a kidney?
For tumors up to 4 cm (T1a) and in many cases up to 7 cm, partial nephrectomy gives the same oncological result as removing the entire kidney, but preserves function - this reduces the risk of chronic kidney disease, cardiovascular complications and is important for a solitary kidney, bilateral tumors, diabetes and hypertension. Current standards recommend resection for all tumors where it is technically feasible.
Difficulty categories and access
In the price list, resection is divided by tumor size: up to 4 cm, 4–7 cm, more than 7 cm - the larger and deeper the tumor, the more difficult the kidney reconstruction and the longer the ischemia. Laparoscopic resection is the standard for peripheral and exophytic tumors; open is performed for central, multiple tumors, a single kidney and complex anatomy, when tactile control and minimal ischemia time are needed.
Results
Local recurrence after resection is 2–5%, 5-year survival rate for T1 is 90–95%. The function of the operated kidney decreases slightly if ischemia does not exceed 20–25 minutes. The main complications are bleeding and urinary drip (3–5%), which are controlled by drainage and, if necessary, embolization or a stent.
