Open Partial Nephrectomy for Localized Renal Tumors in a Resource Limited Setting: Feasibility, Oncologic Outcomes, and Renal Preservation

Background/Objectives: Renal cell carcinoma (RCC) increasingly presents at localized stages, and nephron-sparing surgery is the preferred treatment where feasible. In low- and middle-income countries (LMICs), however, open radical nephrectomy remains predominant due to limited technology and expertise. This study evaluates the feasibility, functional outcomes, and oncologic efficacy of open partial nephrectomy (OPN) in a resource-limited setting. Methods: We conducted a retrospective review of 38 patients with localized renal tumors (cT1–T2 N0M0) who underwent OPN at two tertiary hospitals in Cameroon between 2015 and 2024. Sociodemographic, perioperative, pathological, and follow-up data were analyzed. Primary outcomes included trifecta achievement (negative margins, warm ischemia time ≤25 minutes, and absence of ≥Clavien II complications), renal function preservation, and two-year recurrence-free survival (RFS). Logistic regression identified predictors of functional decline and trifecta non-achievement. Results: Median patient age was 56 years, with a male predominance (63%). Mean tumor size was 4.6 cm; 42% were cT1a, 50% cT1b, and 8% cT2a. All procedures were completed without conversion. The mean warm ischemia time was 17.7 minutes, and transfusion was required in 10.5% of patients. Overall complication rate was 34%, all minor. Negative surgical margins were achieved in 97.4%. Two-year RFS was 94.7%, with no cancer-specific deaths. Mean eGFR declined by 13.4% at 12 months; warm ischemia time independently predicted significant functional loss. Trifecta was achieved in 79% of cases. Conclusions: OPN is feasible and safe in LMICs, providing excellent cancer control and renal preservation. Wider adoption could reduce the burden of chronic kidney disease in resource-limited settings.