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There has been repeated evidence providing support for the role of nephron-sparing surgery for smaller and surgically favourable renal lesions, with radical nephrectomy having been demonstrated to be an independent risk factor for the development of chronic renal failure and its complications [1]. Patients with radical nephrectomy-induced chronic renal insufficiency have a 25% increased risk of cardiac death and a 17% increased risk of death from any cause compared to patients undergoing nephron preservation surgery for cT1b tumours [2].

Despite this evidence, data from the USA and Australia have indicated a continuing under-utilization of nephron-sparing surgery for small renal masses, with significant regional and institutional variation [3, 4]. The present study again brings to our attention the importance of viewing any renal mass in the overall context of the patient's expected longevity and associated medical morbidities, with the ultimate goal being cure from an early renal malignancy without compromising the future renal capability of an individual's nephron mass to ensure expected longevity. The message arising from this and other related publications should not be neglected.

References

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  2. References
  • 1
    Huang WCLA, Serio AM, Snyder M et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 2006; 7: 735
  • 2
    Weight CJ, Larson BT, Fergany AF et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 2010; 183: 13171323
  • 3
    Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Wei JT. National utilisation trends of partial nephrectomy for renal cell carcinoma: a case of underutilisation? Urology 2006; 67: 254259
  • 4
    Ta A, Dimech M, White V et al. Overtreatment of small renal masses in Victoria – should we be concerned? BJU Int 2012; 109 (Suppl. 4): 36