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Treatment of localised renal cell carcinoma |
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| Authors: | Van Poppel Hein Becker Frank Cadeddu Jeffrey A Gill Inderbir S Janetschek Gunther Jewett Michael A S Laguna M Pilar Marberger Michael Montorsi Francesco Polascik Thomas J Ukimura Osamu Zhu Gang |
| Affiliation: | a Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium b Department of Urology, University of Saarland, Homburg, Germany c Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA d USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA e Department of Urology, Medical University Salzburg, Salzburg, Austria f Division of Urology, Princess Margaret Hospital and University Health Network, University of Toronto, Ontario, Canada g Department of Urology, Academic Medical Centre, University Hospital, Amsterdam, The Netherlands h Department of Urology, Medical University of Vienna, Vienna, Austria i Department of Urology, Università Vita Salute San Raffaele, Milan, Italy j Division of Urology, Duke University, Durham, NC, USA k Department of Urology, Beijing Hospital, Beijing, China |
| Abstract: | ContextThe increasing incidence of localised renal cell carcinoma (RCC) over the last 3 decades and controversy over mortality rates have prompted reassessment of current treatment.ObjectiveTo critically review the recent data on the management of localised RCC to arrive at a general consensus.Evidence acquisitionA Medline search was performed from January 1, 2004, to May 3, 2011, using renal cell carcinoma, nephrectomy (Medical Subject Heading [MeSH] major topic), surgical procedures, minimally invasive (MeSH major topic), nephron-sparing surgery, cryoablation, radiofrequency ablation, surveillance, and watchful waiting.Evidence synthesisInitial active surveillance (AS) should be a first treatment option for small renal masses (SRMs) <4 cm in unfit patients or those with limited life expectancy. SRMs that show fast growth or reach 4 cm in diameter while on AS should be considered for treatment. Partial nephrectomy (PN) is the established treatment for T1a tumours (<4 cm) and an emerging standard treatment for T1b tumours (4-7 cm) provided that the operation is technically feasible and the tumour can be completely removed. Radical nephrectomy (RN) should be limited to those cases where the tumour is not amenable to nephron-sparing surgery (NSS). Laparoscopic radical nephrectomy (LRN) has benefits over open RN in terms of morbidity and should be the standard of care for T1 and T2 tumours, provided that it is performed in an advanced laparoscopic centre and NSS is not applicable. Open PN, not LRN, should be performed if minimally invasive expertise is not available. At this time, there is insufficient long-term data available to adequately compare ablative techniques with surgical options. Therefore ablative therapies should be reserved for carefully selected high surgical risk patients with SRMs <4 cm.ConclusionsThe choice of treatment for the patient with localised RCC needs to be individualised. Preservation of renal function without compromising the oncologic outcome should be the most important goal in the decision-making process. |
| Keywords: | Renal cell carcinoma Small renal mass Active surveillance Radical nephrectomy Partial nephrectomy Nephron-sparing surgery Cryotherapy Radiofrequency ablation |
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