With advances in refined imaging assessment and robot-assisted minimally invasive techniques, partial nephrectomy (PN) has been increasingly applied in patients with T₂ renal cell carcinoma (RCC). This study aimed to compare the mid- to long-term outcomes of PN and radical nephrectomy (RN) in patients with T₂ RCC, and to evaluate the safety and feasibility of PN in this setting.

The clinical data of 246 patients with T₂ RCC who underwent surgical treatment at our center between January 2017 and December 2025 were retrospectively analyzed, including 61 patients in the PN group and 185 in the RN group. The primary endpoints were disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). To reduce bias caused by baseline differences between groups, an average treatment effect on the treated (ATT) weighting method based on propensity scores was applied.

Among the 61 patients in the PN group, 2 experienced recurrence or metastasis, and no deaths were observed. In the RN group, 20 of 185 patients developed recurrence or metastasis, and 14 patients died, of whom 12 died from RCC. After ATT weighting, no statistically significant differences were observed between the two groups in DFS (P=0.116), OS (P=0.147), or CSS (P=0.088). The percentage decline in postoperative estimated glomerular filtration rate (eGFR) was significantly lower in the PN group than in the RN group (P<0.001).

Under careful patient selection and appropriate surgical practice, partial nephrectomy can achieve oncologic outcomes comparable to radical nephrectomy in patients with T₂ RCC, and may therefore be considered a reasonable surgical option in selected patients.