The role of nephron-sparing surgery in the management of small renal masses: Comparing the oncological outcomes, renal function preservation, and complication rates of partial nephrectomy versus radical nephrectomy
1Babar Ali Raza, 2Abdul Razzaq Nasir, 3Dr Muhammad ishaq, 4Mobeen Ali, 5Umar Khan, 6Dr Muhammad Aqib Javed
Submission: 12 January 2026 | Acceptance: 29 January 2026 | Publication: 02 March 2026
1UHS, Lahore
2Consultant Urologist Associate Professor Institute Bolan Medical College Hospital.
3Consultant nephrologist DHQ hospital Rajanpur
4PIMS
5PIMS
6Mother and Child Hospital Mianwali, Punjab
ABSTRACT:
Background: The management of small renal masses (SRMs) has evolved with a growing emphasis on preserving renal function while maintaining oncological outcomes. Nephron-sparing surgery, particularly partial nephrectomy (PN), has emerged as a viable alternative to radical nephrectomy (RN) for treating SRMs. However, the comparison of oncological outcomes, renal function preservation, and complication rates between these two surgical approaches remains an area of debate.
Aim: This study aimed to compare the oncological outcomes, renal function preservation, and complication rates of partial nephrectomy versus radical nephrectomy in the management of small renal masses.
Methods: A retrospective cohort study was conducted on patients who underwent either partial nephrectomy or radical nephrectomy for SRMs (≤4 cm) between 2010 and 2020. Oncological outcomes, including recurrence-free survival (RFS) and overall survival (OS), were assessed. Renal function was evaluated through the estimated glomerular filtration rate (eGFR) pre- and post-operatively. Complication rates were compared using the Clavien-Dindo classification. Statistical analyses, including Kaplan-Meier survival curves and Cox regression, were employed to assess the differences between the two groups.
Results: A total of 200 patients (100 partial nephrectomy and 100 radical nephrectomy) were included in the study. Oncological outcomes revealed no significant difference in recurrence-free survival or overall survival between the two groups (p = 0.78). However, partial nephrectomy was associated with a significantly better preservation of renal function, with a median eGFR decrease of 12% compared to 25% in the radical nephrectomy group (p < 0.01). Complication rates were lower in the partial nephrectomy group, with fewer patients experiencing major complications (Clavien-Dindo grade III or higher, p = 0.03).
Conclusion: Partial nephrectomy demonstrated comparable oncological outcomes to radical nephrectomy for small renal masses, with superior renal function preservation and a lower complication rate. These findings support partial nephrectomy as the preferred surgical option for SRMs, wherever feasible, to optimize both functional and oncological outcomes.
Keywords: Nephron-sparing surgery, partial nephrectomy, radical nephrectomy, small renal masses, renal function preservation, oncological outcomes, complication rates.