EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Abstract

Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

“…1 Currently, the incidence of PSMs after elective NSS ranges from 0% to 7%. 10 Our series report an overall incidence of PSMs of 4.9%, which is comparable to the results of other NSS series, regardless of the surgical approach (open vs. minimally invasive).…”

“…The excision of the tumor with a minimal margin of healthy parenchyma surrounding the neoplasm is currently considered the standard technique for partial nephrectomy (PN), to minimize the risk of PSMs and achieve optimal local cancer control. 1 In recent years, large series have reported the results of simple enucleation of renal masses showing functional and oncological results equivalent to standard PN. 7 In all cases, NSS might result in incomplete cancer removal, thus causing PSMs, which might need additional follow-up and can lead to a potentially increased risk of local recurrence and disease progression.…”

Clampless laparoscopic partial nephrectomy: a step towards a harmless nephron-sparing surgery?

“…It has been proved that partial nephrectomy (PN) is the treatment of choice in cases of surgical, clinical T1 tumors (< 7 cm) (1). During PN, whole renal hilum or renal artery alone clamping is typically performed, because it is vital to decrease blood losses, allowing improved visualization, which is paramount to achieve negative oncological margins and to perform precise kidney reconstruction.…”

The Effects of Radical Nephrectomy and Nephron Sparing Surgery on Glomerular Filtration Rate for the Patients who Underwent Surgery for Localized Renal Mass

“…Bu bağlamda böbreğe lokalize RHK'nin güncel tedavisi; mükemmel sağkalım ve yüz güldürücü onkolojik sonucu nedeniyle NKC'dir (19). Avrupa ve Amerika Üroloji Dernekleri'nin kılavuzlarında T1 böbrek tümörü tedavisinde artık NKC altın standart yöntem olmuş ve komorbiditesi nedeniyle cerrahisi riskli olan hastalarda ablatif yöntemler ve izlem kendine yer bulmuştur (1,20).…”

“…Konunun devamındaki paragraf ikinci sütuna geçtiğinde başlık ile aynı hizada olacak (diğer paragraf ile değil)Böbrekte yer işgal eden en yaygın solid lezyon renal hücreli karsinomdur (RHK) ve tüm böbrek tümörlerinin yaklaşık %90'ını oluşturur (1). Yetişkinlerdeki tüm kanserlerin yaklaşık %3'ünü oluşturan RHK, ürogenital sistemin en agresif tümörlerindendir ve prostat ile mesane kanserinden sonra 3. sıklıkta görülür (2).…”