Due to the wide application of imaging techniques such as ultrasound, CT and MRI, incidental kidney cancer is gradually increasing, and these tumors have the characteristics of smaller size, lower stage, slow growth rate and low metastatic potential, which have better prognosis than symptomatic kidney cancer, and surgery is the gold standard for the treatment of limited kidney cancer. Nevertheless, not all patients should have the affected kidney removed! Partial nephrectomy has recently become a new procedure for the treatment of T1a (tumor less than 4 cm and confined within the renal envelope) renal cell carcinoma. For these patients, partial nephrectomy can achieve the same results as total nephrectomy in terms of tumor recurrence and tumor resection outcome. A growing number of studies have demonstrated the relationship between chronic kidney disease and cardiovascular disease and the increased risk of death and hospitalization when GFR decreases <60 mL/min. Total nephrectomy is considered a risk factor for the development and progression of CKD, and the preservation of renal units associated with partial nephrectomy can mitigate these effects. Partial nephrectomy offers advantages in terms of long-term maintenance of renal and cardiovascular function. Therefore, for patients with kidney cancer, the decision to perform total nephrectomy for the affected kidney should be made on a case-by-case basis.