BERKELEY, CA (UroToday.com) - Nephron-sparing treatment remains, for the most part, grossly underutilized in the management of small renal masses (SRMs) despite a rise in incidentally-detected renal cell carcinoma and a downward stage migration. In the present review, we highlight the treatment outcomes of currently available management strategies for SRMs.
Historical publications depicting currently accepted treatment paradigms were reviewed and the results from the contemporary scientific literature on the subject matter were obtained from the PubMed® search engine. The focus was on studies involving humans, published in the English language, and inclusive of clinical trials, meta-analyses, randomized controlled trials, and evidence-based practice guidelines. Results from contemporary retrospective trials augmented the data when levels I and II evidence were lacking.
Phase 3 clinical trial results substantiate the long-held tenet that partial nephrectomy is equivalent to radical nephrectomy with respect to safety and oncological efficacy. Further, minimally invasive techniques using laparoscopy and robotic assistance to achieve partial nephrectomy appear equally effective to traditional open techniques. Although no prospective randomized studies are currently available, large retrospective studies support the notion that active surveillance and thermal ablative techniques are viable options for appropriately selected patients.
The management of SRMs encompasses a host of therapeutic options, all of which must be considered with their respective merits and drawbacks and discussed with an individual patient.
Philippe E. Spiess, MD, MS, FRCS(C), FACS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL USA 33612