Advantages of open resection
In complex anatomy, open access gives the surgeon palpable control of the tumor, rapid identification of vessels and, most importantly, the ability to cool the kidney, extending the safe ischemia time to 40–60 minutes for thorough reconstruction of the calyces and parenchyma. This is critical in case of a single kidney, a tumor in the hilum, multiple formations (hereditary syndromes) and after previous operations. Blood loss is higher than with laparoscopy, recovery is 6–8 weeks, but the functional and oncological result for complex tumors is better.
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.
