The arguments in favor of partial nephrectomy (PN) over radical nephrectomy (RN) for patients with localized renal cell carcinoma (RCC) have been diverse and compelling,1 leading many to advocate for PN whenever feasible, even for potentially aggressive tumors.2 However, some patients with tumors with increased oncologic potential and/or high complexity may not be well-served by PN, and exactly where the appropriate boundaries between PN and RN should reside remains a point of great controversy.3 Many academic urologists are naturally biased in favor of PN because they enjoy the surgical challenges inherent to the procedure, and there are many patients, such as those with preexisting chronic kidney disease (CKD), who clearly benefit from a nephron-sparing approach.4,5 From a practical standpoint, a policy of PN whenever potentially feasible encourages referral to tertiary care centers.