Renal preservation therapy has been a promising concept for the treatment of localized renal cell carcinoma (RCC) for 20 years. Nowadays partial nephrectomy (PN) is well accepted to treat the localized RCC and the oncological control is proved to be the same as the radical nephrectomy (RN). Under the result of well oncological control, minimal invasive method gains more popularity than the open PN, like laparoscopic partial nephrectomy (LPN) and robot assisted laparoscopic partial nephrectomy (RPN). On the other hand, thermoablative therapy and cryoablation also play an important role in the renal preservation therapy to improve the patient procedural tolerance. Novel modalities, but limited to small number of patients, include high-intensity ultrasound (HIFU), radiosurgery, microwave therapy (MWT), laser interstitial thermal therapy (LITT), and pulsed cavitational ultrasound (PCU). Although initial results are encouraging, their real clinical roles are still under evaluation. On the other hand, active surveillance (AS) has also been advocated by some for patients who are unfit for surgery. It is reasonable to choose the best therapeutic method among varieties of treatment modalities according to patients' age, physical status, and financial aid to maximize the treatment effect among cancer control, patient morbidity, and preservation of renal function. 1. Introduction With the improvement of the detection modalities (ultrasound, high-quality computed tomography, etc.), the cases of small renal mass (SRMs) increased. In imaging study, 20% highly suspected renal malignancy would be finally proved as benign pathology after operation. On the other hand, studies proved that the more remaining kidney tissue we have, the lower prevalence the chronic kidney disease (CKD) would happen. Thus treatment gradually focused on the renal preservation therapy. To treat the patients with SRMs, three factors should be balanced: patient morbidity, preservation of renal function, and cancer control. In surgical part, nephron-sparing surgery (NSS)/partial nephrectomy (PN) have evolved from the treatment option to the standard management for small renal masses, have been shown to have equivalent oncological efficacy as radical nephrectomy (RN), while reducing the prevalence of the subsequent renal insufficiency. With the same oncological control, the goal of current surgical intervention is to decrease the risk of CKD. Preservation of renal function may be associated with improved survival and avoided of the risk of cardiovascular death. In ablative therapy, radiofrequency
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