Incidental small renal mass: current management

Abstract

Selected cases of small renal masses can be observed with low risk of metastases, but this does not equate to zero risk. Nephron sparing surgery such as laparoscopic partial nephrectomy or open partial nephrectomy offers optimal oncological outcomes, nephron preservation and improved general prognosis. While there are no 'gold standards' in the management of the small renal mass, laparoscopic partial nephrectomy has demonstrated improving outcomes and minimal complications in the hands of an experienced surgeon. The challenge will be to encourage adoption of this technique, to ensure proficiency, but also be cognisant of the potential risks for lower volume surgeons. The role of ablative procedures is limited to the poor surgical candidate, and as an alternative to the technically difficult laparoscopic procedure. Until long-term data is available, this position is unlikely to change.

Renal Paraganglioma: Report of a Case Managed by Robotic Assisted Laparoscopic Partial Nephrectomy and Review of the Literature

“…Renal cell carcinoma must be considered in the differential diagnosis of every renal mass lesion, even in incidentally detected solid renal masses, since such incidentally discovered renal masses account for about 50% of all currently diagnosed RCCs [13]. Current imaging techniques cannot reliably determine malignancy in a renal mass [12], although the likelihood of malignancy is increased by certain imaging characteristics such as size, shape, contours, and contrast enhancement.…”

Should We Perform Thoracic Imaging for Every Patient with a Renal Mass?

“…Günümüzde renal kitleler genellikle başka nedenlerle yapılan görüntülemeler sırasında rastlantısal olarak ve küçük boyutlarda saptanmaktadır (1). Renal hücreli karsinom (RHK) tanısı konan hastaların yaklaşık %30'unun tanı anında metastatik lezyonları mevcuttur.…”

Percutaneous renal tumour biopsy

“…While numerous studies have correlated tumour size with outcome it is recognised that these observations are not absolute and that even tumours <1 cm in diameter have malignant potential . For this reason tissue diagnosis has an important influence on the planning of definitive therapy, although at present the role of RTB, especially for the management of small renal malignancies, is not formally defined.…”

“…2 While numerous studies have correlated tumour size with outcome 3,4 it is recognised that these observations are not absolute and that even tumours <1 cm in diameter have malignant potential. 5 For this reason tissue diagnosis has an important influence on the planning of definitive therapy, although at present the role of RTB, especially for the management of small renal malignancies, is not formally defined. In a survey of American Urological Association members, significant co-morbidities, patient age and an intention to conduct active surveillance were considered appropriate indications for RTB.…”