New Modalities in Management ofSmall Renal Tumors
Mohamed Mohmoud Hassan Mohamed;
Abstract
Theincidentaldetectionofasmallrenalmasshasincreased,likelyasaresultofmorefrequentimagingperformedforanunrelatedreasonorasapartofanevaluationforothersymptoms.Arenallesionmeasuring<4cminlargestdimensionthatdemonstratescontrastenhancementonabdominalimagingmeetscriteriaforasmallrenalmass.Thevastmajorityofsmallrenalmassesarerenalcellcarcinomas(RCCs). However,upto30percentoflesions<2cmarebenign.Neithertumorsizeatdiagnosisnorthegrowthrateisanaccuratepredictorofthepresenceofrenalcellcarcinoma.
Forpatientswithanincidentallydetectedsmallrenalmass,arenalcomputedtomography(CT)ormagneticresonanceimaging(MRI)arerecommendedasthefirststepincharacterizingthelesion.
Percutaneousbiopsyisindicatedinpatientswithmassessuspectedtobeametastasis,focalinfection,andinpatientsinwhomsurgeryisnotbeingcontemplated(eg,duetocomorbidities,solitarykidney,orknownunresectabledisease).
Surgicalremovalisthestandardofcareforsmallrenaltumors.NSSachievesequivalentoncologicoutcomesandbetterpreservationofrenalfunctioncomparedwithRNandisthereforetheprimarytreatmentchoicewhenevertechnicallyfeasible.LPNisanalternativetoOPNinexperiencedhands.RAPNcanreducethetechnicalchallengesassociatedwithLPN.However,althoughthefirstexperiencesareencouraging,oncologicoutcomesarestillimmature,andthetechniqueisstillunderevaluation.
TheobservationthatasignificantproportionofSRMsarebenigntumoursorlowgradeRCCswithrelativelyindolentclinicalbehaviorhasledtolessinvasivetreatmentoptionsforselectedpatientswhohaveashorterlifeexpectancy,includingminimallyinvasiveATsandAS.
RFAisaminimallyinvasivesafetreatmentoptionforRCCwithlowrateofrecurrenceandprolongedmetastases-freeandCSSratesat5yearsaftertreatment.Postablationimagingiscriticalfortheassessmentofablationsuccess.Atpresent,thistherapyshouldonlybereservedforsmallertumorsinnonsurgicalpatientsbecausefurtherlongertermstudiesarerequiredtodetermineitslongtermoncologicaloutcome.
CryoablationisanalternativetherapyforthetreatmentofSRMsthatisrecommendedincertaincomorbidpopulations.Cryoablation isassociatedwithfewerperioperativecomplicationsandsimilarlongtermoutcomesinappropriatelyselectedpatients.Patientsundergoingcryoablationmayhavehigherratesoflocaldiseaserecurrencecomparedtopatientsthatundergoextirpativetherapy.Ultimately,renalcryoablationallowsurologistswithoutadvancedlaparoscopictrainingtoprovideappropriatelyselectedpatientswithaminimallyinvasivenephronsparingalternativetoradicalnephrectomy.
Forpatientswithanincidentallydetectedsmallrenalmass,arenalcomputedtomography(CT)ormagneticresonanceimaging(MRI)arerecommendedasthefirststepincharacterizingthelesion.
Percutaneousbiopsyisindicatedinpatientswithmassessuspectedtobeametastasis,focalinfection,andinpatientsinwhomsurgeryisnotbeingcontemplated(eg,duetocomorbidities,solitarykidney,orknownunresectabledisease).
Surgicalremovalisthestandardofcareforsmallrenaltumors.NSSachievesequivalentoncologicoutcomesandbetterpreservationofrenalfunctioncomparedwithRNandisthereforetheprimarytreatmentchoicewhenevertechnicallyfeasible.LPNisanalternativetoOPNinexperiencedhands.RAPNcanreducethetechnicalchallengesassociatedwithLPN.However,althoughthefirstexperiencesareencouraging,oncologicoutcomesarestillimmature,andthetechniqueisstillunderevaluation.
TheobservationthatasignificantproportionofSRMsarebenigntumoursorlowgradeRCCswithrelativelyindolentclinicalbehaviorhasledtolessinvasivetreatmentoptionsforselectedpatientswhohaveashorterlifeexpectancy,includingminimallyinvasiveATsandAS.
RFAisaminimallyinvasivesafetreatmentoptionforRCCwithlowrateofrecurrenceandprolongedmetastases-freeandCSSratesat5yearsaftertreatment.Postablationimagingiscriticalfortheassessmentofablationsuccess.Atpresent,thistherapyshouldonlybereservedforsmallertumorsinnonsurgicalpatientsbecausefurtherlongertermstudiesarerequiredtodetermineitslongtermoncologicaloutcome.
CryoablationisanalternativetherapyforthetreatmentofSRMsthatisrecommendedincertaincomorbidpopulations.Cryoablation isassociatedwithfewerperioperativecomplicationsandsimilarlongtermoutcomesinappropriatelyselectedpatients.Patientsundergoingcryoablationmayhavehigherratesoflocaldiseaserecurrencecomparedtopatientsthatundergoextirpativetherapy.Ultimately,renalcryoablationallowsurologistswithoutadvancedlaparoscopictrainingtoprovideappropriatelyselectedpatientswithaminimallyinvasivenephronsparingalternativetoradicalnephrectomy.
Other data
| Title | New Modalities in Management ofSmall Renal Tumors | Other Titles | الطرق الحديثة لتشخيص وعلاج الأورام صغيرة الحجم بالكلى | Authors | Mohamed Mohmoud Hassan Mohamed | Issue Date | 2016 |
Attached Files
| File | Size | Format | |
|---|---|---|---|
| G11162.pdf | 321.52 kB | Adobe PDF | View/Open |
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