Treatment of Localized Kidney Cancer

The incidence of new cases of renal cell carcinoma is increasing in the United States. Many of these new cases of RCC are small localized renal tumors that have been discovered incidentally, raising the importance of having an evidence based approach to their surgical treatment. Renal tumors may now be observed without immediate treatment, radically extirpated, removed sparing the normal surrounding kidney, or ablated in situ using a variety of energy sources, and the options are further increased by the possibility of performing each modality through an open incision, laparoscopically, or percutaneously. In this chapter, we review the oncological, perioperative, and renal functional outcomes relating to the following three technical decisions for the surgical treatment of localized RCC: 1) the use of nephron-sparing surgery 2) the performance of lymph node dissection and 3) the use laparoscopic approach for radical nephrectomy. The studies that were deemed to be the best in the literature and that compared these surgical variables to the default gold standard (open radical nephrectomy with lymph node dissection) were assessed. Recommendations for the best use of these techniques, based on the GRADE level of evidence, are offered.