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KMID : 1001020100080030115
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Korean Journal of Urological Oncology
2010 Volume.8 No. 3 p.115 ~ p.121
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Management of Small Renal Masses: Nephron Sparing Surgery
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Jeon Yoon-Soo
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Abstract
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The incidence of small renal mass is increasing due to prevalent cross sectional imaging. A contemporary review of the indications, techniques, and outcomes is presented for nephron sparing surgeries (NSS) to small renal masses. Clinical literatures for nephron sparing surgery to small renal mass were reviewed. Open and laparoscopic NSS were evaluated and analysed in terms of indication, techniques, and clinical and oncological outcomes. The long-term data regarding open NSS have demonstrated equal oncological outcomes compared to radical nephrectomy. The indications for the maximal preservation of renal parenchyma have been expanded to patients with small, localized, often incidental tumors and a normal contralateral kidney. Laparoscopic approaches to NSS have shown similarly favorable clinical results. Functional and oncological outcomes were not different in open and laparoscopic NSS for renal cell carcinoma. However, laparoscopic NSS had a longer ischemic time and higher perioperative complication rates. NSS is a standard of care for patient with small renal mass under not only imperative but also elective indication. Although oncological and functional outcomes of laparoscopic NSS are acceptable when compared to those of open NSS, which has a longer warm ischemic time and higher perioperative morbidity. Laparoscopic NSS should be considered for select case such as peripheral, exophytic and small renal mass and also in experienced hand.
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KEYWORD
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Kidney, Renal cell carcinoma, Nephron sparing surgery, Nephrectomy
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