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At the recent Society of Urologic Oncology (SUO) conference in Washington, USA, Dr Steven Campbell reviewed the controversial topic of nephron-sparing surgery (partial nephrectomy) for stage cT1b-T2 kidney masses, i.e. tumours that are confined to the kidney but which are greater than 4 cm in diameter.
Partial nephrectomy is recommended for small renal masses (stage cT1a), which are less than 4 cm in diameter. It is generally preferred for patients with pre-existing chronic kidney disease and familial renal cell carcinoma (RCC). The optimal management of with larger localised kidney tumours (cT1b-T2) is less clear.
There have been several clinical studies investigating the risk and benefits of partial nephrectomy, but there is a lack of information about the use of partial nephrectomy for larger tumours confined to the kidney. Current clinical practice for the removal of these tumours is based on individual decision-making and recognition of the lack of good quality data.
Dr Campbell suggested that the following factors be considered during decision-making for partial nephrectomy of cT1b-T2 kidney tumours:
- Age of the patient and co-morbidities
- Number of foci in the tumour
- Family history of RCC
- Kidney function
- Tumour complexity
- Careful review of imaging features