Controversies in the Surgical Management of Renal Cancer

Abstract

Renal tumors are a common cause of cancer, and renal cell carcinoma accounts for the vast majority of the renal tumors in the United States. The past two decades have produced numerous advances in the treatment of localized and metastatic renal cell carcinoma. Nephron-sparing surgery, laparoscopic nephrectomy, and energy-ablative techniques are now in the armamentarium of the urologist. The role of adrenalectomy and lymphadenectomy are better understood today than in decades past, and recent advances in the understanding of immunotherapy, cytoreductive nephrectomy, and metastatic disease have also improved treatment for this disease. As is often the case as technology and knowledge evolve, controversies regarding the surgical treatment of renal cancer exist. This article outlines some of these controversies and reviews the evidence surrounding each.