Emerging Nephron Sparing Treatments for Kidney Tumors: A Continuum of Modalities From Energy Ablation to Laparoscopic Partial Nephrectomy

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Abstract
The current global medical trend toward minimally invasive treatment for various tumors has generated special interest in several minimally invasive options in the management of kidney tumors. We discuss the role of nephron sparing surgery by less invasive options than the time-honored partial nephrectomy, and the current multitude of energy based tumor ablative methods. We searched the English literature following the introduction of nephron sparing surgery, with special attention to various emerging minimally invasive surgical and ablative alternatives. Laparoscopic partial nephrectomy can be performed safely following the surgical oncology principles established by open partial nephrectomy. Initial results from the various energy based modalities, most notably cryoablation, indicate that high local control rates can be achieved. However, caution is advised since viable tissue has been observed after minimally invasive ablative therapies. Available data, while promising, are still lacking for long-term followup. Compared to open partial nephrectomy the laparoscopic approach offers similar cancer-free survival rates. However, the procedure requires highly skilled surgeons. Of the energy based ablative treatments cryoablation followed by radio frequency ablation offers the most meaningful results, with promising local control rates indicated in some series. These methods can be performed less invasively than partial nephrectomy and require less surgical expertise. We anticipate that these modalities will be formalized into urological practice and serve as a single continuum of care, customized according to disease and surgical expertise.