American Urologic Association (AUA) Guidelines for the Treatment of Kidney Cancer
Full Kidney Removal Not Necessary For All Kidney Tumors
AUA Press Release, April 26, 2009
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Early-stage renal masses should be treated with Nephron-Sparing approaches when possible
Radical nephrectomy (complete removal of the affected kidney) is not the best treatment for most small kidney tumors because it puts patients at risk for chronic kidney disease and cardiovascular disease
Detection of clinical stage 1 (<7.0 cm) renal masses has increased in frequency and is now a common clinical scenario for the practicing urologist. Of these tumors, 20 percent are benign, 60 percent are indolent kidney cancer, and only about 20 percent are potentially aggressive kidney cancer at the time of diagnosis
Radical nephrectomy is currently greatly overutilized. Whenever possible, it is important to preserve renal function by taking a nephron-sparing approach
Partial Nephrectomy: Surgical excision by partial nephrectomy is a reference standard for the management of clinical T1 renal masses, whether for imperative or elective indications, given the importance of preservation of renal function and avoidance of chronic kidney disease
In general, open partial nephrectomy is preferred for complex cases such as hilar tumor location and solitary kidney
Thermal Ablation: Thermal ablation (cryoablation or radiofrequency ablation), performed either percutaneously or laparoscopically, is an appealing treatment option for the patient at high surgical risk who wants active treatment and accepts the need for long-term radiographic surveillance.
Counseling about thermal ablation should include a balanced discussion of the increased risk of local recurrence when compared to surgical excision, the potential need for reintervention, the potential for difficult surgical salvage if tumor progression is found and the substantial limitations of the current thermal ablation literature.
Active Surveillance: Active surveillance is a reasonable option for the management of localized renal masses that should be a primary consideration for patients with decreased life expectancy or extensive comorbidities that would increase the risks of intervention.
However, more aggressive or larger tumors (>3 to 4 cm) should be managed in a proactive manner, if possible.
Radical Nephrectomy: Radical nephrectomy is still occasionally required.
A laparoscopic approach should be considered because it is associated with a more rapid recovery profile.