New AUA Guidelines: Radical Nephrectomy May Be Avoidable for Early-Stage Renal Tumors

April 28, 2009

By Martha Kerr

CHICAGO (Reuters Health) Apr 27 - The American Urological Association has issued its first guidelines on the management of patients with early stage renal carcinoma. The guidelines state that nephron-sparing surgery may be sufficient, rather than a full radical nephrectomy, and should be considered for stage T1 tumors that are less than 7.0 cm in size.

AUA Guideline Committee chairman Dr. Steven C. Campbell of the Cleveland (Ohio) Clinic presented the new guidelines here during the AUA's 104th annual meeting.

Nephron-sparing treatment such as partial nephrectomy, thermal ablation and active surveillance may provide adequate cancer control while minimizing the risk of chronic kidney disease and the increase in cardiovascular risk associated with removal of a whole kidney, Dr. Campbell announced.

"Nephron-sparing surgery should be considered for all patients with a clinical T1 renal mass, presuming adequate oncological control can be achieved," he said.

"Surgical excision by partial nephrectomy is the reference standard for the management of clinical T1 renal masses, whether for imperative or elective indications, given the importance of renal function and avoidance of chronic kidney disease," Dr. Campbell noted.

"Radical nephrectomy is still a viable option when necessary, based on tumor size, location and radiographic appearance if nephron-sparing surgery is deemed inadvisable."

"Thermal ablation...is an available treatment option for the patient at high surgical risk who wants active treatment and accepts the need for long-term surveillance," the guidelines state. "Larger tumors (more than 3.5 cm) and those with irregular shape or infiltrative appearance may be associated with increased risk of recurrence when managed with thermal ablation."

"Active surveillance is a reasonable option for the management of localized renal masses...and should be a primary consideration for patients with decreased life expectancy or extensive co-morbidities that would increase the risks of intervention," Dr. Campbell and colleagues say. Active surveillance is gaining ground as a treatment approach, he told Reuters Health.

"More aggressive or larger tumors, 3 to 4 centimeters in size, should be managed in a proactive manner, if possible."

"Kidney tumors can be the most insidious of urologic tumors, and it is of the utmost importance that they be assessed promptly and thoroughly and that the proper treatment (is) offered," Dr. Campbell emphasized. "It is equally important to consider preserving renal function whenever possible."

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