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Surveillance for the Management of Small Renal Masses  [PDF]
Mehmet Ozsoy,Tobias Klatte,Matthias Waldert,Mesut Remzi
Advances in Urology , 2008, DOI: 10.1155/2008/196701
Abstract: Surveillance is a new management option for small renal masses (SRMs) in aged and infirm patients with short-life expectancy. The current literature on surveillance of SRM contains mostly small, retrospective studies with limited data. Imaging alone is inadequate for suggesting the aggressive potential of SRM for both diagnosis and followup. Current data suggest that a computed tomography (CT) or magnetic resonance imaging (MRI) every 3 months in the 1st year, every 6 months in the next 2 years, and every year thereafter, is appropriate for observation. The authors rather believe in active surveillance with mandatory initial and followup renal tumor biopsies than classical observation. Since not all SRMs are harmless, selection criteria for active surveillance need to be improved. In addition, there is need for larger studies in order to better outline oncological outcome and followup protocols.
Histological Characterisation of Small Renal Masses and Incidence of Silent Renal Masses  [PDF]
Sergio Almenar Medina,Ana Calatrava Fons
Advances in Urology , 2008, DOI: 10.1155/2008/758073
Abstract: With the introduction of sonographic and CT examinations, the number of small renal masses detected has increased. Benign neoplastic lesions are usually smaller than 4 cm in size, whilst the most common types of renal cell carcinomas have a mean size greater than that, but we must not forget that a significant number of small masses are renal cell carcinomas; even though the rate of benign cases increases as the diameter of the lesions decreases, therefore, size itself cannot be used to rule out a diagnostic of malignancy and often image characteristics are not enough to predict the nature of the lesion with certainty. In this case, histological confirmation must be recommended. Ideally, the histological study must be conducted on the surgical specimen, even though biopsy can be an option in selected cases.
High-Intensity Focused Ultrasound in Small Renal Masses  [PDF]
Jose Rubio Briones,Argimiro Collado Serra,Alvaro Gómez-Ferrer Lozano,Juan Casanova Ramón-Borja,Inmaculada Iborra Juan,Eduardo Solsona Narbón
Advances in Urology , 2008, DOI: 10.1155/2008/809845
Abstract: High-intensity focused ultrasound (HIFU) competes with radiofrequency and cryotherapy for the treatment of small renal masses as a third option among ablative approaches. As an emerging technique, its possible percutaneous or laparoscopic application, low discomfort to the patient and the absence of complications make this technology attractive for the management of small renal masses. This manuscript will focus on the principles, basic research and clinical applications of HIFU in small renal masses, reviewing the present literature. Therapeutic results are controversial and from an clinical view, HIFU must be considered a technique under investigation at present time. Further research is needed to settle its real indications in the management of small renal masses; maybe technical improvements will certainly facilitate its use in the management of small renal masses in the near future.
Cryoablation for Small Renal Masses  [PDF]
J. L. Dominguez-Escrig,K. Sahadevan,P. Johnson
Advances in Urology , 2008, DOI: 10.1155/2008/479495
Abstract: Advances in imaging techniques (CT and MRI) and widespread use of imaging especially ultrasound scanning have resulted in a dramatic increase in the detection of small renal masses. While open partial nephrectomy is still the reference standard for the management of these small renal masses, its associated morbidity has encouraged clinicians to exploit the advancements in minimally invasive ablative techniques. The last decade has seen the rapid development of laparoscopic partial nephrectomy and novel ablative techniques such as, radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation (CA). In particular, CA for small renal masses has gained popularity as it combines nephron-sparing surgery with a minimally invasive approach. Studies with up to 5-year followup have shown an overall and cancer-specific 5-year survival of 82% and 100%, respectively. This manuscript will focus on the principles and clinical applications of cryoablation of small renal masses, with detailed review of relevant literature.
The Role of Surveillance in the Management of Small Renal Masses  [cached]
Alessandro Volpe
The Scientific World Journal , 2007, DOI: 10.1100/tsw.2007.157
Abstract:
The fate of small renal masses, less then 1 cm size: outcome study
Lang, Erich K.;Hanano, Amer;Rudman, Ernest;Thomas, Raju;Myers, Leann;Nguyen, Quan;Macchia, Richard J.;
International braz j urol , 2012, DOI: 10.1590/S1677-55382012000100006
Abstract: purpose: we evaluated the outcome and etiologies of small renal masses (less than 1 cm in size) discovered incidentally on 2 consecutive cts that investigated non-urologic abdominal complaints. materials and methods: a retrospective search for incidentally discovered small renal masses, less then 1 cm in size, was carried out in the files of 6 major us medical centers. 4822 such lesions had been reported over a 12 year period. a search of these patients' records revealed 1082 subsequent new cts for non urologic complaints, allowing the assessment of the fate of the masses. lesions enlarging, of ambivalent contour or enhancement were examined by a third multiphasic mdct. the findings were interpreted by 2 blinded radiologists. results: six hundred and four masses could no longer be identified, 231 were significantly smaller, 113 unchanged in size and 134 larger. of the disappearing lesions 448 were located in the medulla, 94 both in medulla and cortex and 62 in cortex. multiphasic mdcts obtained in 308 masses enlarging, unchanged in size or of ambivalent appearance, revealed 7 neoplasms, 45 inflammatory lesions, 8 abscesses and 62 renal medullary necrosis. concurrent antibiotic therapy of gi conditions may have caused some of the 496 lesions to disappear. conclusion: it is questionable whether the small number of malignant neoplasms (0.4%), inflammatory lesions (5%) and renal medullary necrosis (6%) justify routine follow-up cts and exposure to radiation. the delay in intervention in neoplastic lesions probably didn't influence tumor-free survival potential and clinical symptoms would soon have revealed inflammatory conditions. with exception of ambivalent lesions, clinical surveillance appears adequate.
Familial Syndromes Coupling with Small Renal Masses  [PDF]
Jorge Hidalgo,Gilberto Chéchile
Advances in Urology , 2008, DOI: 10.1155/2008/413505
Abstract: During the past two decades, several new hereditary renal cancers have been discovered but are not yet widely known. Hereditary renal cancer syndromes can lead to multiple bilateral kidney tumors that occur at a younger age than that at which the nonhereditary renal cancers occur. The aim of our work is to review the features of hereditary renal cancers, the basic principles of genetic relevant to these syndromes, and the various histopathologic features of renal cancer. In addition, we will describe the known familial syndromes associated with small renal masses.
Small Renal Masses: Incidental Diagnosis, Clinical Symptoms, and Prognostic Factors  [PDF]
F. M. Sánchez-Martín,F. Millán-Rodríguez,G. Urdaneta-Pignalosa,J. Rubio-Briones,H. Villavicencio-Mavrich
Advances in Urology , 2008, DOI: 10.1155/2008/310694
Abstract: Introduction. The small renal masses (SRMs) have increased over the past two decades due to more liberal use of imaging techniques. SRMs have allowed discussions regarding their prognostic, diagnosis, and therapeutic approach. Materials and methods. Clinical presentation, incidental diagnosis, and prognosis factors of SRMs are discussed in this review. Results. SRMs are defined as lesions less than 4 cm in diameter. SRM could be benign, and most malignant SMRs are low stage and low grade. Clinical symptoms like hematuria are very rare, being diagnosed by chance (incidental) in most cases. Size, stage, and grade are still the most consistent prognosis factors in (RCC). An enhanced contrast SRM that grows during active surveillance is clearly malignant, and its aggressive potential increases in those greater than 3 cm. Clear cell carcinoma is the most frequent cellular type of malign SRM. Conclusions. Only some SRMs are benign. The great majority of malign SRMs have good prognosis (low stage and grade, no metastasis) with open or laparoscopic surgical treatment (nephron sparing techniques). Active surveillance is an accepted attitude in selected cases.
Open Partial Nephrectomy in the Management of Small Renal Masses  [PDF]
Ziya Kirkali,A. Erdem Canda
Advances in Urology , 2008, DOI: 10.1155/2008/309760
Abstract: Introduction. Most of the kidney masses are being detected incidentally with smaller size due to widespread use of imaging modalities leading to increased RCC incidence worldwide with an earlier stage. This article reviews the role of open partial nephrectomy (PN) in the management of small renal masses. Material and Methods. Review of the English literature using MEDLINE has been performed between 1963–2008 on small renal masses, partial nephrectomy, kidney cancer, nephron sparing surgery (NSS), radical nephrectomy, laparoscopy, and surgical management. Special emphasis was given on the indications of NSS, oncological outcomes and comparison with open and laparoscopic PN. Results. Overall 68 articles including 31 review papers, 35 human clinical papers, 1 book chapter, and 1 animal research study were selected for the purpose of this article and were reviewed by the authors. Conclusions. Currently, open NSS still remains as the gold standard surgical treatment modality in patients with small renal masses.
Renal Preservation Therapy for Renal Cell Carcinoma  [PDF]
Yichun Chiu,Allen W. Chiu
International Journal of Surgical Oncology , 2012, DOI: 10.1155/2012/123596
Abstract: Renal preservation therapy has been a promising concept for the treatment of localized renal cell carcinoma (RCC) for 20 years. Nowadays partial nephrectomy (PN) is well accepted to treat the localized RCC and the oncological control is proved to be the same as the radical nephrectomy (RN). Under the result of well oncological control, minimal invasive method gains more popularity than the open PN, like laparoscopic partial nephrectomy (LPN) and robot assisted laparoscopic partial nephrectomy (RPN). On the other hand, thermoablative therapy and cryoablation also play an important role in the renal preservation therapy to improve the patient procedural tolerance. Novel modalities, but limited to small number of patients, include high-intensity ultrasound (HIFU), radiosurgery, microwave therapy (MWT), laser interstitial thermal therapy (LITT), and pulsed cavitational ultrasound (PCU). Although initial results are encouraging, their real clinical roles are still under evaluation. On the other hand, active surveillance (AS) has also been advocated by some for patients who are unfit for surgery. It is reasonable to choose the best therapeutic method among varieties of treatment modalities according to patients' age, physical status, and financial aid to maximize the treatment effect among cancer control, patient morbidity, and preservation of renal function. 1. Introduction With the improvement of the detection modalities (ultrasound, high-quality computed tomography, etc.), the cases of small renal mass (SRMs) increased. In imaging study, 20% highly suspected renal malignancy would be finally proved as benign pathology after operation. On the other hand, studies proved that the more remaining kidney tissue we have, the lower prevalence the chronic kidney disease (CKD) would happen. Thus treatment gradually focused on the renal preservation therapy. To treat the patients with SRMs, three factors should be balanced: patient morbidity, preservation of renal function, and cancer control. In surgical part, nephron-sparing surgery (NSS)/partial nephrectomy (PN) have evolved from the treatment option to the standard management for small renal masses, have been shown to have equivalent oncological efficacy as radical nephrectomy (RN), while reducing the prevalence of the subsequent renal insufficiency. With the same oncological control, the goal of current surgical intervention is to decrease the risk of CKD. Preservation of renal function may be associated with improved survival and avoided of the risk of cardiovascular death. In ablative therapy, radiofrequency
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