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

Read more in UroToday here