Treatment of localised renal cell carcinoma

Hein Van Poppel, Frank Becker, Jeffrey A Cadeddu, Inderbir S. Gill, Gunther Janetschek, Michael A S Jewett, M. Pilar Laguna, Michael Marberger, Francesco Montorsi, Thomas J. Polascik, Osamu Ukimura, Gang Zhu

Research output: Contribution to journalReview article

155 Scopus citations

Abstract

Context: The increasing incidence of localised renal cell carcinoma (RCC) over the last 3 decades and controversy over mortality rates have prompted reassessment of current treatment. Objective: To critically review the recent data on the management of localised RCC to arrive at a general consensus. Evidence acquisition: A Medline search was performed from January 1, 2004, to May 3, 2011, using renal cell carcinoma, nephrectomy (Medical Subject Heading [MeSH] major topic), surgical procedures, minimally invasive (MeSH major topic), nephron-sparing surgery, cryoablation, radiofrequency ablation, surveillance, and watchful waiting. Evidence synthesis: Initial active surveillance (AS) should be a first treatment option for small renal masses (SRMs) <4 cm in unfit patients or those with limited life expectancy. SRMs that show fast growth or reach 4 cm in diameter while on AS should be considered for treatment. Partial nephrectomy (PN) is the established treatment for T1a tumours (<4 cm) and an emerging standard treatment for T1b tumours (4-7 cm) provided that the operation is technically feasible and the tumour can be completely removed. Radical nephrectomy (RN) should be limited to those cases where the tumour is not amenable to nephron-sparing surgery (NSS). Laparoscopic radical nephrectomy (LRN) has benefits over open RN in terms of morbidity and should be the standard of care for T1 and T2 tumours, provided that it is performed in an advanced laparoscopic centre and NSS is not applicable. Open PN, not LRN, should be performed if minimally invasive expertise is not available. At this time, there is insufficient long-term data available to adequately compare ablative techniques with surgical options. Therefore ablative therapies should be reserved for carefully selected high surgical risk patients with SRMs <4 cm. Conclusions: The choice of treatment for the patient with localised RCC needs to be individualised. Preservation of renal function without compromising the oncologic outcome should be the most important goal in the decision-making process.

Original languageEnglish (US)
Pages (from-to)662-672
Number of pages11
JournalEuropean urology
Volume60
Issue number4
DOIs
StatePublished - Oct 1 2011

Keywords

  • Active surveillance
  • Cryotherapy
  • Nephron-sparing surgery
  • Partial nephrectomy
  • Radical nephrectomy
  • Radiofrequency ablation
  • Renal cell carcinoma
  • Small renal mass

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'Treatment of localised renal cell carcinoma'. Together they form a unique fingerprint.

  • Cite this

    Van Poppel, H., Becker, F., Cadeddu, J. A., Gill, I. S., Janetschek, G., Jewett, M. A. S., Laguna, M. P., Marberger, M., Montorsi, F., Polascik, T. J., Ukimura, O., & Zhu, G. (2011). Treatment of localised renal cell carcinoma. European urology, 60(4), 662-672. https://doi.org/10.1016/j.eururo.2011.06.040