Introduction Currently, the gold standard for T1a renal cell carcinoma treatment is partial nephrectomy (PN). However, active surveillance (AS) is increasing in elderly individuals with co-morbidities. Our hypothesis was that individuals choosing active surveillance would have similar cancer specific survival as partial nephrectomy. Method This retrospective study used electronic notes to collect patient data presenting with T1a renal cell carcinoma, identified over a 15-year period. Primary outcomes were to compare the survival outcomes of these patients while being related to their comorbidities using the Charlson Comorbidity Index (CCI). Results 183 patients were identified with 62 (35%) and 121 (65%) undergoing PN and AS respectively. Patients treated with AS were older (mean age of 66 years vs 58 years; P 70 affected overall survival independently between the two groups (HR 5.85; CI 3.29-10.42; P Conclusions The study agreed with the hypothesis of similar cancer specific survival. Highlighting for elderly individuals with significant co-morbidities, there is no observed benefit for undergoing partial resection.