The evolving landscape of renal surgery for complex renal masses (CRM): implications for oncologic and functional outcomes

Partial nephrectomy (PN) has become the standard of treatment for most T1 renal masses and is suitable for selected T2 renal cortical masses. In this setting, the management of complex renal masses (CRM) requires a thorough understanding of the potential risks and benefits of both PN and radical nephrectomy (RN). Indeed, thanks to the advent of robotic surgery, indications of PN have expanded to include larger tumors and CRM, despite the associated surgical complexity and oncologic risks. The decision-making process for CRM treatment with PN or RN is complex. Thus, the current review aims to explore the decision-making essentials for patients with CRM, identify research gaps, and address the clinical challenge of determining the most suitable surgical approach. Current evidence suggests that while PN offers a clear advantage in renal tissue preservation, it may carry higher perioperative risks compared to RN. However, these risks should be balanced with the long-term benefits of renal function preservation. In conclusion, further high-quality, prospective studies are needed to better define the comparative effectiveness of PN vs. RN to guide clinical decision-making for CRM.