Renal cell carcinoma medical therapy
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 small - 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
- ↑ 1.0 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.
- ↑ 2.0 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.
- ↑ 3.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.