Nephron Sparing Surgery for Renal Cell Carcinoma 4 Cm. Or Less in Diameter: Indicated or Under Treated?

Abstract

The metastatic potential and biology of these small nodules are not yet known. To lower the risk of local recurrence the results of our study suggest that nephron sparing surgery might be advisable in patients with renal cell carcinoma 20 mm. or less in diameter.

Venous spread of renal cell carcinoma: MDCT

“…The most suitable lesion for this type of surgery is the one with <4 cm in diameter, situated cortically, on the pole of the kidney, far from the hilum and collecting system. Accurate assessment of intrarenal spread of RCC, infiltration of renal pelvis, renal vessels and perirenal fat tissue is necessary for planning the nephron-sparing surgery [33,34]. In patients who are not surgical candidates, accurate staging gives important information considering the prognosis.…”

O estadiamento TNM do carcinoma de células renais deve ser modificado novamente ?

“…O comportamento biológico dos pequenos tumores renais permanece desconhecido 11,12 , mesmo assim a conduta pode ser expectante para casos selecionados 13 , por outro lado, há muito tempo relaciona-se o diâ-metro do tumor e potencial maligno 14 . A incidência de tumores com menos de 4 cm aumentou de 28%, em 1985, para 61% em 1995 12 e o tamanho médio dos tumores reduziu de 7,8 cm, em 1989, para 5,3 cm em 1998 15 .…”

“…A incidência de tumores com menos de 4 cm aumentou de 28%, em 1985, para 61% em 1995 12 e o tamanho médio dos tumores reduziu de 7,8 cm, em 1989, para 5,3 cm em 1998 15 . Quanto à evolução, tumores menores de 4cm têm excelente prognóstico quando tratados com nefrectomia radical ou cirurgia conservadora 8,10,15 , contudo resultados semelhantes foram obtidos para tumores inferiores a 7 cm, porém a maioria desta casuística era composta por tumores com menos de 4 cm 16 .…”

Current Status of Partial Nephrectomy in the Management of Kidney Cancer

“…An increase in incidentally detected tumors is due to the widespread use of ultrasound and CT in most fields of clinical medicine. 79,80 The majority of those incidental tumors show a low pathologic stage. [81][82][83][84] However, Novick 19 notes that radical nephrectomy is still considered the definitive form of surgical treatment due to (1) the low risk of a metachronous contralateral RCC (1% to 2%), (2) a local tumor recurrence rate of approximately 5% after partial nephrectomy, [47][48][49] and (3) occasional cases of unsuspected multicentricity that would not be treated by partial nephrectomy.…”

“…85 In recent years, it has become clear that the tumor size is of great significance for the clinical outcome of these patients. 79,88 Also, it is generally accepted that nephron-sparing surgery should be performed only if the tumor lesion has a diameter of less than 4 cm; otherwise, total nephrectomy is recommendable. Wunderlich and colleagues 79 in their 1998 autopsy study suggests that nephron-sparing surgery might be advisable in patients with RCC that is 2-cm or less in diameter if there is an imperative indication in cases of RCC larger than 2 cm.…”