Preserved renal unit surgery (NSS) allows for better preservation of renal function; for benign and clinically inert tumors, NSS can reduce the risk of overtreatment. However, NSS for renal cell carcinoma is still not widely used, especially in non-teaching hospitals. In recent years, a growing number of clinical studies have suggested that preserving the renal unit reduces the incidence of cardiovascular events compared to radical nephrectomy (RN). These findings make preserving the renal unit appear to have significant advantages, but there is also a clear bias: in fact, underlying conditions such as hypertension and diabetes can influence the choice of procedure. The European Organization for Research and Treatment of Cancer (EORTC) trial found that renal unit-preserving surgery did not improve patient survival. With this in mind, Dr. Capitanio and others at an Italian institute conducted a multi-institutional study to try to understand the impact of resected tumor and patient underlying disease and treatment modality (renal unit preserving surgery versus radical nephrectomy) on the risk of cardiovascular events after kidney cancer, and published the results in a recent issue of European Urology. The study included 1331 kidney cancer cases from 1987 to 2013 in which patients had normal renal function (i.e., estimated glomerular filtration rate of R60 ml/min/1.73 m2) prior to surgery. Of these, 462 (approximately 1/3) underwent radical nephrectomy (radical nephrectomy) and 869 (approximately 2/3) underwent renal unit-preserving surgery, the latter including open (most), lumpectomy, and robotic-assisted surgery. Stratified analysis according to treatment modality revealed that patients undergoing renal unit-preserving surgery had lower rates of cardiovascular events at 1, 5, and 10 years than patients undergoing radical nephrectomy. Univariate analysis found a significant association between treatment modality (preserved renal unit surgery vs radical nephrectomy) and cardiovascular events, while multivariate analysis suggested that patients with preserved renal unit surgery had a significantly lower risk of cardiovascular events than patients with radical nephrectomy. Preserved renal unit surgery is currently the standard of care for clinical stage T1 renal cancer if technically feasible in the hospital. Studies have shown that renal unit-preserving surgery does not differ from radical nephrectomy in terms of tumor treatment, but renal unit-preserving surgery has a better prognosis than radical nephrectomy. In addition, the risk of cardiovascular events with renal surgery cannot be ignored, and this study illustrates that the incidence of cardiovascular events in RSS patients is almost half that of radical nephrectomy patients, which can significantly reduce the risk of cardiovascular events associated with radical nephrectomy.