In recent years, the incidence of kidney cancer continues to rise, and more patients have been seen in Hip Wo. As far as I remember, in the past era, most of the patients underwent radical nephrectomy for kidney cancer, but nowadays, more of them have kidney cancer surgery with preservation of kidney, why there is such a big change, and what is right and wrong. Patients have different opinions when they meet different doctors, of course, they are confused, sometimes they do not know whether they have made the right choice or not, and even have regrets. For huge kidney tumor, no matter whether it is malignant or benign, as long as the volume or diameter exceeds one-third of the kidney, basically we have to consider taking out all the kidneys, that is, radical surgery. If malignant tumors are suspected also add to the surgery the removal of surrounding components suspected of metastasis, such as complete removal of the fat capsule, lymph nodes, and adrenal glands. However, one thing to be aware of before removing such a large tumor is that the other kidney is already dysfunctional for other reasons, or there are factors that potentially jeopardize its function. If this factor is not taken into consideration and the diseased kidney is removed without any reservation or fear, the opposite kidney will not be able to fulfill the body’s need for detoxification and fluid removal after the operation, which will lead to renal failure sooner or later. Therefore, it is important to assess the function of each kidney before surgery and to choose the correct surgical method. Resection of giant renal tumors is a risky and complex procedure. It involves adhesions to the surrounding organs and bleeding. Adhesion refers to the fact that the tumor grows partially or completely together with the surrounding intestines, large blood vessel walls, liver, spleen, and other organs, which cannot be separated independently, making it impossible to achieve non-invasive resection of the renal tumor, resulting in serious intraoperative and postoperative complications, even life-threatening. Bleeding refers to the presence of many thick blood vessels on the surface of the tumor, which can easily cause rupture of blood vessels during the exploration and separation process, and more bleeding can easily lead to shock. In that case, it is not possible to take into account whether the tumor is removed cleanly or not, and it is not easy to stop the bleeding and save the life. Both of the above points require the surgeon to be bold and meticulous, to have a clear mind, to be delicate and careful in operation, to be steady in mind and technique during operation, to make reasonable decisions, and to cooperate with assistants properly to realize the success of the operation in one go. Otherwise it can lead to big problems during or after the operation because of small obstacles. Nowadays, due to the popularity of medical checkups and the strengthening of public health awareness, many small and medium-sized renal tumors continue to be detected and patients actively seek treatment. We have accumulated a lot of experience in the field of effective kidney preservation and clean tumor removal. Early renal tumors are generally defined as tumors less than 4 cm in diameter. Patients basically have no subjective sensation, occasionally react with lumbar distension, and rarely have hematuria of the naked eye, all of which are detected by ultrasound or CT. In the past, patients would choose radical nephrectomy, that is, total excision, after basic diagnosis by CT examination. However, nowadays, we are more likely to do “nephrectomy of renal tumor with preservation of renal unit”. As the standard of living has improved, detoxification and fluid removal are very important, and the life expectancy of the population is increasing, preserving kidney function as much as possible has become a new demand of patients. In fact, research in the field of urology confirms this: under the premise of standardized resection of the tumor, the effective preservation of the normal tissue remaining in the kidney does not lead to an increase in the recurrence rate of the tumor, and it can prolong the patient’s life. A retrospective study of a large number of cases also confirms that the postoperative tumor recurrence rate of renal cancer surgery with scientifically executed kidney preservation is the same as that of radical nephrectomy. This conclusion provides a scientific basis for doctors and patients to boldly choose kidney preservation, which is also the preferred treatment recommended by the urological community in the United States, Europe and China. The difficulty of the surgical procedure, the increased risk of surgery, and the threat of postoperative complications prevent many physicians and patients from making a firm choice. If we consider the patient’s age and frailty, choosing total nephrectomy is also a responsible attitude towards the patient. In any case, total nephrectomy is an alternative to partial nephrectomy. Especially if the patient is evaluated for local lymph node metastasis, tumor invasion of renal blood vessels, etc., total nephrectomy should be chosen, and clean tumor removal is the absolute first priority. I usually do not recommend intraoperative rapid pathology to determine whether the tumor is benign or malignant. Because the diagnosis rate of intraoperative rapid frozen section is not high, and most malignant tumors have obvious margins, logically speaking, since the choice of surgery, the surgeon will generally be able to judge accurately and cleanly resected, in this case, regardless of benign and malignant does not affect the surgical operation method, which will delay the surgical process and increase the amount of bleeding. Unless the patient insists on knowing the benign or malignant nature of the disease and asks for radical surgery. Whether to perform open surgery or laparoscopic surgery depends on the patient’s physical condition, the depth and breadth of tumor invasion, the characteristics of renal vascular distribution, as well as the doctor’s opinion of the difficulty of the operation. After all, the dexterity of both hands is incomparable to the two long pincers in the abdominal cavity under the TV mirror, so when encountering more complicated tumors, choosing open surgery is also an option to ensure the operation standardization, smooth operation, reduce the operation risk and operation time, and ensure the clean tumor resection and reduce the bleeding to the maximum extent. For the patients who have already metastasized widely, are very weak, or are very old, and the doctors are not sure about the clean operation, it is suggested to consider the overall situation, and the targeted drug therapy can be considered to shrink the tumor before considering the operation. Patients with limited renal cancer can undergo kidney-sparing surgery, and if they are too weak, they can also be considered for laparoscopic minimally invasive tumor cryotherapy, which is also very effective. We have also treated patients with multiple and bilateral renal tumors, as well as patients with renal cancer invading the heart, with excellent results. I have learned that it is important to properly evaluate the patient and family before surgery to gain an understanding of the condition. So far, we have done many cases and none of them has yet to have serious complications. In many cases, we have even boldly predicted that there is a 95% chance that the patient will live as long as a healthy person after surgery. The above is only my personal experience and opinion, as science is constantly advancing and there must be limitations of the times.