What are contraindications for partial nephrectomy nephron-sparing surgery (NSS)?

Updated: Apr 01, 2019
  • Author: Reza Ghavamian, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Nephron-sparing surgery (NSS) is generally contraindicated in the presence of obvious nodal metastases. This information is usually obtained based on preoperative cross-sectional imaging. CT scanning can help detect extensive lymphadenopathy that is most likely secondary to tumor metastases. However, CT scanning does not reveal limited lymph node involvement, and a small number of patients are found to have enlarged lymph nodes on CT scans that are not involved with tumor at the time of surgery. Importantly, do not deny these patients the potential for cure and renal preservation based on false-positive findings on CT scans. In addition, the status of equivocal lymph nodes can be assessed by intraoperative frozen sections. The role of positron emission tomography (PET) scanning in this scenario is not well known (see Imaging Studies).Partial nephrectomy is also contraindicated in the presence of inferior vena cava thrombus and a normal contralateral kidney. In the rare clinical scenario of a solitary kidney and an inferior vena cava thrombus, NSS can be considered if the primary lesion is anatomically amenable to resection.


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