Buenos Aires, Argentina (UroToday.com) Mark Frydenberg, Professor at Manesh University in Melbourne, Australia, presented an overview of management of SRMs using surgery. There is clear over treatment of SRMs. Technique for partial nephrectomy are evolving with recent surge in robotic versus pure laparoscopic partial nephrectomy with decreased learning curve, decreased complications and equivalent oncology efficacy (positive margins) in robotic versus laparoscopic series. Partial nephrectomy has inherent predictors for complications including patient factors (age, comorbidities) and tumor characteristics (nephrometry score). About 4-6% of patients experience complications following partial nephrectomy including but not limited to hemorrhage, urine leaks and even bowel injury. While overall survival may be equivalent for cT1a tumors, survival of patients with cT1b tumors is superior by about 3-fold for patients treated with partial nephrectomy versus ablative therapy. Therefore, size and location of tumor are critical when determining surgery versus ablation with surgery preferred for larger and anterior tumors. Surgical resection after failed thermal ablation is challenging with 44% of patients requiring nephrectomy and all patients reported in recent series having attempted partial nephrectomy. Given the excellent cancer-specific survival up to 99% in patients treated with surgery for SRMs and minimal complications when performed by expert surgeons, surgery remains the standard of care for treatment of SRMs.
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Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.