**1. Introduction**

328 Chronic Kidney Disease

Cruz J, Restrepo C A. Accidental implantation of hemodialysis catheter in persistent left

For many years, radical nephrectomy (RN) has been the gold standard treatment for renal tumours. However, at present the available evidence supports elective nephron-sparing surgery (NSS) as the standard surgical treatment for renal cortical tumours ≤4 cm (clinical stage T1a). Furthermore, an increasing body of evidence demonstrates that even a minor loss of renal function can increase cardiovascular morbidity and consequently reduce life expectancy (Go et al., 2004). Thus, surgeons have the responsibility to preserve as much renal parenchyma as possible.

International guidelines at present recommend NSS for small renal tumours up to 4 cm. However, the role of NSS for larger renal tumours (stage T1b: 4.1 – 7 cm, stage T2: >7 cm) remains controversial. During the last couple of years, data has emerged which demonstrates that NSS can be safely performed with acceptable complication rates compared to RN (Van Poppel et al., 2010). The advantage of NSS lies in avoiding the development of end-stage renal disease and the need for haemodialysis, while maintaining quality of life (Lesage et al., 2007).

The size of the tumour is no longer considered to be a limiting factor for NSS and some now advocate NSS whenever possible and feasible (Becker et al., 2009).
