Organ preserving surgery for kidney tumors is gaining popularity with the purpose of preserving kidney function and avoiding comorbidities associated with kidney failure. Possible improvements in overall patient survival may be due to the ability of organ saving surgery to better preserve renal function compared to radical nephrectomy. Organ preserving surgery, as recommended, is currently contraindicated in kidney tumors at stage T3. There are currently few clinical studies comparing kidney resection and nephrectomy in the presence of venous spread. For the later stages of locally advanced kidney tumors, organ preserving surgery is not recommended, but it is becoming increasingly probable that it can be performed with results similar to those with radical nephrectomy. Patients who underwent organ preserving surgery had similar oncologic and better functional results. Therefore, a T3a kidney tumor should not be a deterrent to organ-saving surgery when technically possible to perform by qualified surgeons. In the presence of imperative indications (single kidney, neoplasm of both kidneys, chronic renal failure and others), even with the spread of the tumor into the venous bed, organ preserving surgery is considered necessary for the patient. Dialysis is associated with a large number of complications, which leads to the avoidance of the renoven condition. Cases of preserving the kidney in the course of intravenous tumor spread are very rare clinical observations. Nowadays there are only a few observations in the literature regarding organ preserving surgery in the spread of a tumor into the renal vein with conflicting results raising a number of questions about the oncological, technical, and ethical aspects of this problem, about the feasibility of organ preserving surgery. The oncological safety of such operations has not yet been demonstrated, and the purpose of preserving kidney function should not put the patient at increased risk for recurrence and progression of cancer, severe complications and death. There is very limited literature data regarding organ preserving kidney surgery with venous spread of the tumor. The article contains publications concerning organ saving surgery for intravenous kidney cancer, showing the oncological feasibility of organ saving surgery for elective or imperative indications for surgery. With a short follow-up, a low percentage of systemic progression was observed. In contrast, there is data about the negative results of such operations. The article presents the results of systematic analysis of the largest, existing series of organ preserving surgery for venous tumor spread with oncological and functional results of treatment and complications, which show that organ preserving surgery does not increase the risk of disease prolongation, recurrence and neoplasm in comparison with radical nephrectomy, but with the occurrence of more complications. It is concluded that organ preserving surgery with removal of "tumor thrombus" by imperative indications is a complicated, long-lasting operation with acceptable oncological and functional results, which may be accompanied by significant blood loss and increased risk of complications, and better preservation of renal function than in case of radical nephrectomy. On this basis, further promising large multicenter studies are needed to clarify the feasibility and the role of organ preserving surgery of renal tumors with intravenous spread in imperative indications.

Keywords: kidney tumors, organ preserving surgery, radical nephrectomy, intravenous tumor spread

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