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Small renal masses are defined as masses that are less than or equal to 4 cm on CT scan enhancement. Optimal management of small renal masses includes open or laparoscopic partial nephrectomy.<ref name="pmid17574056">{{cite journal| author=Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR et al.| title=Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. | journal=J Urol | year= 2007 | volume= 178 | issue= 1 | pages= 41-6 | pmid=17574056 | doi=10.1016/j.juro.2007.03.038 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17574056  }} </ref><ref name="pmid18221958">{{cite journal| author=Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS| title=Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. | journal=J Urol | year= 2008 | volume= 179 | issue= 3 | pages= 847-51; discussion 852 | pmid=18221958 | doi=10.1016/j.juro.2007.10.050 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18221958  }} </ref><ref name="pmid19269025">{{cite journal| author=Rini BI, Campbell SC, Escudier B| title=Renal cell carcinoma. | journal=Lancet | year= 2009 | volume= 373 | issue= 9669 | pages= 1119-32 | pmid=19269025 | doi=10.1016/S0140-6736(09)60229-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19269025  }} </ref> Partial nephrectomy is characterized by a low-complication rate. Most common complications include urinary leak and hemorrhage that occur in 3-5% and 1%, respectively.<ref name="pmid17574056">{{cite journal| author=Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR et al.|title=Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. | journal=J Urol | year= 2007 | volume= 178 | issue= 1 |pages= 41-6 | pmid=17574056 | doi=10.1016/j.juro.2007.03.038 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17574056  }}</ref><ref name="pmid18221958">{{cite journal| author=Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS| title=Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. | journal=J Urol| year= 2008 | volume= 179 | issue= 3 | pages= 847-51; discussion 852 |pmid=18221958 | doi=10.1016/j.juro.2007.10.050 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18221958  }}</ref><ref name="pmid19269025">{{cite journal| author=Rini BI, Campbell SC, Escudier B| title=Renal cell carcinoma. | journal=Lancet | year= 2009 | volume= 373 | issue= 9669 | pages= 1119-32 | pmid=19269025 | doi=10.1016/S0140-6736(09)60229-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19269025  }} </ref> Partial nephrectomy is associated with less chronic renal failure (CRF) than with radical nephrectomy, with a rate of CRF ranging between 5-20% and 36-65%, respectively.<ref name="pmid16945768">{{cite journal| author=Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV et al.| title=Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. | journal=Lancet Oncol | year= 2006 | volume= 7 | issue= 9 | pages= 735-40 | pmid=16945768 | doi=10.1016/S1470-2045(06)70803-8 | pmc=PMC2239298 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16945768  }} </ref>
Small renal masses are defined as masses that are less than or equal to 4 cm on CT scan enhancement. Optimal management of small renal masses includes open or laparoscopic partial nephrectomy.<ref name="pmid17574056">{{cite journal| author=Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR et al.| title=Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. | journal=J Urol | year= 2007 | volume= 178 | issue= 1 | pages= 41-6 | pmid=17574056 | doi=10.1016/j.juro.2007.03.038 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17574056  }} </ref><ref name="pmid18221958">{{cite journal| author=Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS| title=Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. | journal=J Urol | year= 2008 | volume= 179 | issue= 3 | pages= 847-51; discussion 852 | pmid=18221958 | doi=10.1016/j.juro.2007.10.050 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18221958  }} </ref><ref name="pmid19269025">{{cite journal| author=Rini BI, Campbell SC, Escudier B| title=Renal cell carcinoma. | journal=Lancet | year= 2009 | volume= 373 | issue= 9669 | pages= 1119-32 | pmid=19269025 | doi=10.1016/S0140-6736(09)60229-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19269025  }} </ref> Partial nephrectomy is characterized by a low-complication rate. Most common complications include urinary leak and hemorrhage that occur in 3-5% and 1%, respectively.<ref name="pmid17574056">{{cite journal| author=Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR et al.|title=Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. | journal=J Urol | year= 2007 | volume= 178 | issue= 1 |pages= 41-6 | pmid=17574056 | doi=10.1016/j.juro.2007.03.038 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17574056  }}</ref><ref name="pmid18221958">{{cite journal| author=Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS| title=Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. | journal=J Urol| year= 2008 | volume= 179 | issue= 3 | pages= 847-51; discussion 852 |pmid=18221958 | doi=10.1016/j.juro.2007.10.050 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18221958  }}</ref><ref name="pmid19269025">{{cite journal| author=Rini BI, Campbell SC, Escudier B| title=Renal cell carcinoma. | journal=Lancet | year= 2009 | volume= 373 | issue= 9669 | pages= 1119-32 | pmid=19269025 | doi=10.1016/S0140-6736(09)60229-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19269025  }} </ref> Partial nephrectomy is associated with less chronic renal failure (CRF) than with radical nephrectomy, with a rate of CRF ranging between 5-20% and 36-65%, respectively.<ref name="pmid16945768">{{cite journal| author=Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV et al.| title=Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. | journal=Lancet Oncol | year= 2006 | volume= 7 | issue= 9 | pages= 735-40 | pmid=16945768 | doi=10.1016/S1470-2045(06)70803-8 | pmc=PMC2239298 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16945768  }} </ref>


Special consideration must be made for patient subgroups, including the elderly and those with high surgical risk. Because the average growth rate of small renal tumors is considered small - approaching 0.28 cm/year and a 1% rate of metastasis - partial nephrectomy may be spared in these patients.<ref name="pmid16406965">{{cite journal| author=Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG| title=The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. | journal=J Urol | year= 2006 | volume= 175 | issue= 2 | pages= 425-31 | pmid=16406965 | doi=10.1016/S0022-5347(05)00148-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16406965  }} </ref><ref name="pmid19269025">{{cite journal| author=Rini BI, Campbell SC, Escudier B| title=Renal cell carcinoma. | journal=Lancet | year= 2009 | volume= 373 | issue= 9669 | pages= 1119-32 | pmid=19269025 | doi=10.1016/S0140-6736(09)60229-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19269025  }} </ref>
Special consideration must be made for patient subgroups, including the elderly and those with high surgical risk. Because the average growth rate of small renal tumors is considered slow - approaching 0.28 cm/year and a 1% rate of metastasis - partial nephrectomy may be spared in these patients.<ref name="pmid16406965">{{cite journal| author=Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG| title=The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. | journal=J Urol | year= 2006 | volume= 175 | issue= 2 | pages= 425-31 | pmid=16406965 | doi=10.1016/S0022-5347(05)00148-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16406965  }} </ref><ref name="pmid19269025">{{cite journal| author=Rini BI, Campbell SC, Escudier B| title=Renal cell carcinoma. | journal=Lancet | year= 2009 | volume= 373 | issue= 9669 | pages= 1119-32 | pmid=19269025 | doi=10.1016/S0140-6736(09)60229-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19269025  }} </ref>
 
====Probe-Based Thermal Ablation====
====Probe-Based Thermal Ablation====
Percutaneous or laparoscopic probe-based thermal ablation is a new management method for patients with small renal masses. The technique utilizes extreme temperatures, such as cryoablation or radiofrequency ablation.<ref name="pmid11068292">{{cite journal| author=Gill IS, Novick AC, Meraney AM, Chen RN, Hobart MG, Sung GT et al.| title=Laparoscopic renal cryoablation in 32 patients. | journal=Urology | year= 2000 | volume= 56 | issue= 5 | pages= 748-53 | pmid=11068292 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11068292  }} </ref><ref name="pmid15879772">{{cite journal| author=Gill IS, Remer EM, Hasan WA, Strzempkowski B, Spaliviero M, Steinberg AP et al.| title=Renal cryoablation: outcome at 3 years. | journal=J Urol | year= 2005 | volume= 173 | issue= 6 | pages= 1903-7 | pmid=15879772 | doi=10.1097/01.ju.0000158154.28845.c9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15879772  }} </ref> Thermal ablation is still considered inferior to partial nephrectomy due to the following considerations:
Percutaneous or laparoscopic probe-based thermal ablation is a new management method for patients with small renal masses. The technique utilizes extreme temperatures, such as cryoablation or radiofrequency ablation.<ref name="pmid11068292">{{cite journal| author=Gill IS, Novick AC, Meraney AM, Chen RN, Hobart MG, Sung GT et al.| title=Laparoscopic renal cryoablation in 32 patients. | journal=Urology | year= 2000 | volume= 56 | issue= 5 | pages= 748-53 | pmid=11068292 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11068292  }} </ref><ref name="pmid15879772">{{cite journal| author=Gill IS, Remer EM, Hasan WA, Strzempkowski B, Spaliviero M, Steinberg AP et al.| title=Renal cryoablation: outcome at 3 years. | journal=J Urol | year= 2005 | volume= 173 | issue= 6 | pages= 1903-7 | pmid=15879772 | doi=10.1097/01.ju.0000158154.28845.c9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15879772  }} </ref> Thermal ablation is still considered inferior to partial nephrectomy due to the following considerations:

Revision as of 20:03, 11 January 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Small Renal Masses

Partial Nephrectomy

Small renal masses are defined as masses that are less than or equal to 4 cm on CT scan enhancement. Optimal management of small renal masses includes open or laparoscopic partial nephrectomy.[1][2][3] Partial nephrectomy is characterized by a low-complication rate. Most common complications include urinary leak and hemorrhage that occur in 3-5% and 1%, respectively.[1][2][3] Partial nephrectomy is associated with less chronic renal failure (CRF) than with radical nephrectomy, with a rate of CRF ranging between 5-20% and 36-65%, respectively.[4]

Special consideration must be made for patient subgroups, including the elderly and those with high surgical risk. Because the average growth rate of small renal tumors is considered slow - approaching 0.28 cm/year and a 1% rate of metastasis - partial nephrectomy may be spared in these patients.[5][3]

Probe-Based Thermal Ablation

Percutaneous or laparoscopic probe-based thermal ablation is a new management method for patients with small renal masses. The technique utilizes extreme temperatures, such as cryoablation or radiofrequency ablation.[6][7] Thermal ablation is still considered inferior to partial nephrectomy due to the following considerations:

  • Difficulty in ablation of large (>3.5 cm) tumors[3]
  • Higher local recurrence rate in thermal ablation[8]
  • Ill-defined radiographic parameters for success in thermal ablation[9]
  • Post-ablation surgery may be compromised due to presence of ablation fibrotic reactions[3]
  • Unavailable long-term data on patients undergoing ablation

Advanced Renal Tumors

References

  1. ↑ 1.0 1.1 Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR; et al. (2007). "Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors". J Urol. 178 (1): 41–6. doi:10.1016/j.juro.2007.03.038. PMID 17574056.
  2. ↑ 2.0 2.1 Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS (2008). "Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney". J Urol. 179 (3): 847–51, discussion 852. doi:10.1016/j.juro.2007.10.050. PMID 18221958.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Rini BI, Campbell SC, Escudier B (2009). "Renal cell carcinoma". Lancet. 373 (9669): 1119–32. doi:10.1016/S0140-6736(09)60229-4. PMID 19269025.
  4. ↑ Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV; et al. (2006). "Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study". Lancet Oncol. 7 (9): 735–40. doi:10.1016/S1470-2045(06)70803-8. PMC 2239298. PMID 16945768.
  5. ↑ Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006). "The natural history of observed enhancing renal masses: meta-analysis and review of the world literature". J Urol. 175 (2): 425–31. doi:10.1016/S0022-5347(05)00148-5. PMID 16406965.
  6. ↑ Gill IS, Novick AC, Meraney AM, Chen RN, Hobart MG, Sung GT; et al. (2000). "Laparoscopic renal cryoablation in 32 patients". Urology. 56 (5): 748–53. PMID 11068292.
  7. ↑ Gill IS, Remer EM, Hasan WA, Strzempkowski B, Spaliviero M, Steinberg AP; et al. (2005). "Renal cryoablation: outcome at 3 years". J Urol. 173 (6): 1903–7. doi:10.1097/01.ju.0000158154.28845.c9. PMID 15879772.
  8. ↑ Kunkle DA, Egleston BL, Uzzo RG (2008). "Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review". J Urol. 179 (4): 1227–33, discussion 1233-4. doi:10.1016/j.juro.2007.11.047. PMID 18280512.
  9. ↑ Weight CJ, Kaouk JH, Hegarty NJ, Remer EM, O'Malley CM, Lane BR; et al. (2008). "Correlation of radiographic imaging and histopathology following cryoablation and radio frequency ablation for renal tumors". J Urol. 179 (4): 1277–81, discussion 1281-3. doi:10.1016/j.juro.2007.11.075. PMID 18280507.
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