Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass: Beyond the Abstract
This review article aims to highlight some of the most relevant recent developments in nephron-sparing surgery and ablative techniques, focusing on some of the most exciting recent work in this area. Some articles of particular significance, highlighted within the review are:
1. “Trifecta” in partial nephrectomy1.
This paper established the concept of the trifecta in partial nephrectomy, an essential standard against which outcomes are now measured in the operation.
2. Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 309042.
This essential study challenged assumptions about renal function post partial nephrectomy and has stimulated further investigations into the refinement of the management of small renal masses.
3. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses3.
This robust observational comparison of outcomes between surgery and ablation (both cryo- and radiofrequency) for small renal masses reported that although overall survival was superior after partial nephrectomy in this cohort, oncological outcomes were equivalent after cryoablation.
This robust observational comparison of outcomes between surgery and ablation (both cryo- and radiofrequency) for small renal masses reported that although overall survival was superior after partial nephrectomy in this cohort, oncological outcomes were equivalent after cryoablation.
Beyond these key studies, a wide range of current developments is discussed, including open, laparoscopic and robot-assisted surgical techniques, approaches to clamping and ischaemia, intraoperative imaging, single site surgery and new robotic platforms. In the context of ablation, we discuss the most recent evidence concerning minimally invasive ablative techniques, the role of renal tumour biopsy (RTB) in the context of ablation and the advantages and disadvantages of different approaches to ablation.
The exciting advances discussed in this review promise to improve cancer clearance and long-term renal function preservation, while patients will experience safer, more reliable and less invasive treatment, for small renal masses.
Written By: J. Withington, J.B. Neves, R. Barod
Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust.
Read the Abstract
References
1. Hung AJ, Cai J, Simmons MN, Gill IS. “Trifecta” in partial nephrectomy. J Urol. 2013;189(1):36–42. doi:10.1016/j.juro.2012.09.042. This paper established the concept of the trifecta in partial nephrectomy, an essential standard against which outcomes are now measured in the operation.
2. Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H. Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol. 2014;65(2):372–7. doi:10.1016/j.eururo.2013.06.044.
3. Thompson RH, Atwell T, Schmit G, Lohse CM, Kurup AN, Weisbrod A, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015;67(2):252–9. doi:10.1016/j.eururo.2014.07.021.