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Management of small renal masses: a review

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Abstract

Introduction

Recently, small renal masses (SRMs) (≤4 cm) are found more frequently, especially in the elderly and co-morbid patients. Standard treatment for SRMs is nephron-sparing surgery (NSS). New techniques like energy ablation and surveillance have been introduced.

Materials and methods

Overview of treatment options for SRMs, based mainly on the meta-analyses available for NSS, cryoablation, radio-frequency ablation (RFA), and surveillance.

Results

NSS for SRMs is the standard therapy with excellent cancer-specific survival rates up to 97%. Cryoablation was mainly performed laparoscopically, and RFA mainly percutaneously. Pretreatment biopsies were used frequently for cryoablation (80%) and less frequently for RFA (50%). Primary failure rate for cryoablation was 4.8% and for RFA 13%. Major complication rates for both procedures are around 5%. Based on 6-month post-ablative biopsies, non-contrast enhancement seems to be an effective surrogate marker after cryoablation, but not after RFA. Follow-up after energy ablation is too short to draw final conclusion. Data on surveillance are based on small, retrospective data with insufficient follow-up. Growth patterns during follow-up do not correlate with the underlying tumour entity.

Conclusion

Standard therapy for SRMs is still NSS. Energy ablation should be reserved for the elderly patients with co-morbidities and surveillance for the elderly and infirm patients.

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Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Mesut Remzi, Elchin Javadli & Mehmet Özsoy

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  1. Mesut Remzi
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  2. Elchin Javadli
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  3. Mehmet Özsoy
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Correspondence to Mesut Remzi.

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Remzi, M., Javadli, E. & Özsoy, M. Management of small renal masses: a review. World J Urol 28, 275–281 (2010). https://doi.org/10.1007/s00345-010-0516-8

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  • DOI: https://doi.org/10.1007/s00345-010-0516-8

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