Renal Cancer in Families With Hereditary Renal Cancer: Prospective Analysis of a Tumor Size Threshold for Renal Parenchymal Sparing Surgery

Abstract

Using a 3 cm. renal tumor diameter as an indication for renal surgery no patient with renal cancer and von Hippel-Lindau disease or hereditary papillary renal cancer had metastatic disease regardless of the number of tumors. Using a lesion size of 3 cm. as a threshold for performing renal parenchymal sparing surgery may help to prevent metastatic disease, unnecessary renal damage due to frequent surgery and renal dialysis or transplantation.

Percutaneous Radio Frequency Ablation of Small Renal Tumors: Initial Results

“…With this strategy we have seen no metastatic renal cancer in greater than 52 patients with hereditary renal cancer to date. 5,20 Percutaneous radio frequency ablation may provide a new alternative for renal masses approaching this 3 cm. threshold and also be an option for sporadic renal tumor in poor surgical candidates.…”

“…rarely metasta-size. [1][2][3][4][5] Management options for small renal masses include observation, experimental ablation and surgical removal. …”

“…in diameter. 5 Percutaneous radio frequency ablation is offered for smaller solid tumors that demonstrate growth during a 1-year period, and initial results are presented.…”

von Hippel–Lindau disease: A clinical and scientific review

“…28 After establishing the growth rate, an individual renal lesion can kept under regular surveillance until it reaches 3 cm diameter when partial nephrectomy (or an alternative technique such as radiofrequency ablation) is performed. 29,25 At the time of surgery any additional smaller lesions that are accessible are removed in order to delay the need for reoperation. Follow-up of VHL patients treated by nephron-sparing surgery reveals a high incidence of local recurrence from new primary tumours, but a low risk of distant metastasis 30 whereas about 25% of VHL patients with more advanced RCC (43 cm) develop metastatic disease.…”

“…Follow-up of VHL patients treated by nephron-sparing surgery reveals a high incidence of local recurrence from new primary tumours, but a low risk of distant metastasis 30 whereas about 25% of VHL patients with more advanced RCC (43 cm) develop metastatic disease. 29 Repeated renal surgery may compromise renal function so that renal replacement therapy is required. Renal transplantation has been undertaken successfully; and it appears that immunosuppression does not affect adversely the underlying course of VHL disease.…”