Guideline for Management of the Clinical T1 Renal Mass

Abstract
Detection of clinical stage 1 (1 x 1 Green, F.L. Kidney. in: D.L. Page, C.M. Batch, I.D. Fleming, (Eds.) AJCC Cancer Staging Manual. Springer Verlag, New York; 2002: 323–328 Google Scholar See all References , 2 x 2 Jemal, A., Siegel, R., Ward, E. et al. Cancer statistics, 2008. CA Cancer J Clin. 2008; 58: 71 Crossref | PubMed | Scopus (9270) | Google Scholar See all References , 3 x 3 Mathew, A., Devesa, S.S., Fraumeni, J.F. Jr et al. Global increases in kidney cancer incidence, 1973–1992. Eur J Cancer Prev. 2002; 11: 171 Crossref | PubMed | Scopus (238) | Google Scholar See all References , 4 x 4 Jayson, M. and Sanders, H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology. 1998; 51: 203 Abstract | Full Text PDF | PubMed | Scopus (557) | Google Scholar See all References These tumors are very heterogeneous, with 20% benign and only about 20–25% exhibiting potentially aggressive kidney cancer at the time of diagnosis.5 x 5 Kutikov, A., Fossett, L.K., Ramchandani, P. et al. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. BJU Int. 2008; 68: 737 Google Scholar See all References , 6 x 6 Snyder, M.E., Bach, A., Kattan, M.W. et al. Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. J Urol. 2006; 176: 2391 Abstract | Full Text | Full Text PDF | PubMed | Scopus (109) | Google Scholar See all References , 7 x 7 Pahernik, S., Ziegler, S., Roos, F. et al. Small renal tumors: correlation of clinical and pathological features with tumor size. J Urol. 2007; 178: 414 Abstract | Full Text | Full Text PDF | PubMed | Scopus (107) | Google Scholar See all References , 8 x 8 Remzi, M., Ozsoy, M., Klingler, H.C. et al. Are small renal tumors harmless? (Analysis of histopathological features according to tumors 4 cm or less in diameter) . J Urol. 2006; 176: 896 Abstract | Full Text | Full Text PDF | PubMed | Scopus (228) | Google Scholar See all References Treatment options have expanded greatly, engendering much controversy in the field.9 x 9 Hollenbeck, B.K., Taub, D.A., Miller, D.C. et al. National utilization trends of partial nephrectomy for renal cell carcinoma: a case of under utilization?. Urology. 2006; 67: 254 Abstract | Full Text | Full Text PDF | PubMed | Scopus (267) | Google Scholar See all References Traditionally, these tumors have been treated aggressively, most often with radical nephrectomy.10 x 10 Clayman, R.V., Kavoussi, L.R., and Soper, N.J. Laparoscopic nephrectomy: Initial case report. J Urol. 1991; 146: 278 Abstract | Full Text PDF | PubMed | Scopus (1210) | Google Scholar See all References , 11 x 11 Russo, P. Open radical nephrectomy for localized renal cell carcinoma. in: N.J. Vogelzang Jr, (Ed.) Comprehensive Textbook of Genitourinary Oncology. Lippincott, Williams & Wilkins, Philadelphia; 2002: 725–731 Google Scholar See all References , 12 x 12 Dunn, M.D., Portis, A.J., and Shalhav, A.L. Laparoscopic versus open radical nephrectomy: 9-year experience. J Urol. 2000; 164: 1153 Abstract | Full Text | Full Text PDF | PubMed | Scopus (470) | Google Scholar See all References , 13 x 13 Nadler, R.B., Loeb, S., Clemens, J.Q. et al. A prospective study of laparoscopic radical nephrectomy for T1 tumors–is transperitoneal, retroperitoneal or hand assisted the best approach?. J Urol. 2006; 175: 1230 Abstract | Full Text | Full Text PDF | PubMed | Scopus (41) | Google Scholar See all References However, this predisposes patients to chronic kidney disease with attendant cardiovascular risks and increased mortality.14 x 14 McKiernan, J., Simmons, R., Katz, J. et al. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology. 2002; 59: 816 Abstract | Full Text | Full Text PDF | PubMed | Scopus (416) | Google Scholar See all References , 15 x 15 Thompson, R.H., Boorjian, S.A., Lohse, C.M. et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared to partial nephrectomy. J Urol. 2008; 179: 468 Abstract | Full Text | Full Text PDF | PubMed | Scopus (479) | Google Scholar See all References Nephron-sparing approaches such as partial nephrectomy,16 x 16 Lee, C.T., Katz, J., Shi, W. et al. Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol. 2000; 163: 730 Abstract | Full Text | Full Text PDF | PubMed | Scopus (528) | Google Scholar See all References , 17 x 17 Lau, W.K., Blute, M.L., Weaver, A.L. et al. Matched comparison of radical nephrectomy vs. nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000; 75: 1236 Abstract | Full Text | Full Text PDF | PubMed | Scopus (587) | Google Scholar See all References , 18 x 18 Leibovich, B.C., Blute, M.L., Cheville, J.C. et al. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004; 171: 1066 Abstract | Full Text | Full Text PDF | PubMed | Scopus (448) | Google Scholar See all References , 19 x 19 Dash, A., Vickers, A.J., and Schachter, L.R. Comparison of outcomes in elective partial vs. radial nephrectomy for clear cell renal cell carcinoma of 4 to 7 cm. BJU Int. 2006; 97: 939 Crossref | PubMed | Scopus (172) | Google Scholar See all References , 20 x 20 Gill, I.S., Kavoussi, L.R., Lane, B.R. et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007; 178: 41 Abstract | Full Text | Full Text PDF | PubMed | Scopus (813) | Google Scholar See all References thermal ablation21 x 21 Kunkle, D.A., Egleston, B.L., and Uzzo, R.G. Cryoablation versus radio frequency ablation of the small renal mass: a meta-analysis of published literature. J Urol. 2008; 179: 328 Abstract | Full Text PDF | Google Scholar See all References , 22 x 22 Gill, I.S., Remer, E.M., Hasan, W.A. et al. Renal cryoablation: outcome at 3 years. J Urol. 2005; 173: 1903 Abstract | Full Text | Full Text PDF | PubMed | Scopus (315) | Google Scholar See all References , 23 x 23 Davol, P.E., Fulmer, B.R., and Rukstalis, D.B. Long-term results of cryoablation for renal cancer and complex renal masses. Urology. 2006; 68: 2 Abstract | Full Text | Full Text PDF | PubMed | Scopus (107) | Google Scholar See all References , 24 x 24 Matin, S.F., Ahrar, K., Cadeddu, J.A. et al. Residual and recurrent disease following renal energy ablative therapy: a multi-institutional study. J Urol. 2006; 176: 1973 Abstract | Full Text | Full Text PDF | PubMed | Scopus (143) | Google Scholar See all References and active surveillance25 x 25 Oda, T., Miyao, N., Takahashi, A. et al. Growth rates of primary and metastatic lesions of renal cell carcinoma. Int J Urol. 2001; 8: 473 Crossref | PubMed | Scopus (76) | Google Scholar See all References , 26 x 26 Chawla, S.N., Crispen, P.L., Hanlon, A.L. et al. The natural history of observed enhancing renal masses: meta-analysis and review of the world. J Urol. 2006; 175: 425 Abstract | Full Text | Full Text PDF | PubMed | Scopus (510) | Google Scholar See all References , 27 x 27 Bosniak, M.A., Birnbaum, B.A., Krinsky, G.A. et al. Small renal parenchymal neoplasms: further observations on growth. Radiology. 1995; 197: 589 PubMed | Google Scholar See all References , 28 x 28 Kunkle, D.A., Crispen, P.L., Chen, D.Y. et al. Enhancing renal masses with zero net growth during active surveillance. J Urol. 2007; 177: 849 Abstract | Full Text | Full Text PDF | PubMed | Scopus (152) | Google Scholar See all References , 29 x 29 Lamb, G.W., Bromwich, E.J., Vasey, P. et al. Management of renal masses in patients medically unsuitable for nephrectomy–natural history, complications, and outcome. Urology. 2004; 64: 909 Abstract | Full Text | Full Text PDF | PubMed | Scopus (87) | Google Scholar See all References have also emerged as viable options for the management of these patients. Recognizing that current practice is potentially discordant with what the literature supports, the Practice Guidelines Committee of the American Urological Association commissioned a Panel to review the literature and provide Guidelines for the management of this challenging patient population.