Renal cell cancer treatment: an expert panel recommendation from the Latin American cooperative group-genitourinary and the Latin American renal cancer group: focus on surgery

Zéqui, Stênio de Cássio; Costa, Walter Henriques da; Korkes, Fernando; Reis, Rodolfo Borges dos; Busato, Wilson Francisco Schreiner; Matheus, Wagner Eduardo; Neto, Deusdedit Cortêz Vieira da Silva; Paula, Felipe de Almeida e; Carvalhal, Gustavo F.; Nogueira, Lucas; Fernandes, Roni de Carvalho; Silva, Adriano Gonçalves e; Sasse, Andre Deeke; Fay, André P.; Jardim, Denis Leonardo Fontes; Bastos, Diogo Assed; Rosa, Diogo Augusto Rodrigues da; Wierman, Evanius; Kater, Fabio; Schutz, Fabio A.B.; Maluf, Fernando C.; Oliveira, Fernando Nunes; Morbeck, Igor Alexandre Protzner; Rinck, José Augusto; Trindade, Karine Martins da; Maia, Manuel Caitano; Souza, Vinicius Carrera; Monteiro, Fernando Sabino Marques; Soares, Andrey

doi:10.1177/1756287219872324

Cited by 3 publications

(1 citation statement)

References 72 publications

(209 reference statements)

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“…The guidelines for the region of Taiwan refers to the EAU guidelines, and the urological societies of the countries of South America represented by the CAU was the same as the AUA guidelines. Further recommendations for the Latin American Renal Cancer Group were found during the literature search (14). Therefore, 7 sets of guidelines were reviewed and recommendations regarding active surveillance are summarised in Table 1.…”

Section: Search Results Of the International Guidelinesmentioning

confidence: 99%

Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices

Cui

Sullivan

2021

Transl Androl Urol

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The management trend of low-risk kidney cancer over the last decade has been from treatment with radical nephrectomy, to use of nephron sparing procedures of partial nephrectomy and ablation, as well as the option of active surveillance (AS). This narrative review aims to summarise the available guidelines related to AS and review the published descriptions of regional practices on the management of low-risk kidney cancer worldwide. A search of PubMed, Google Scholar and Cochrane Library databases for studies published 2010 to June 2020 identified 15 studies, performed between 2000 and 2019, which investigated 13 different cohorts of low-risk kidney cancer patients on AS. Although international guidelines show a level of agreement in their recommendation on how AS is conducted, in terms of patient selection, surveillance strategy and triggers for intervention, cohort studies show distinct differences in worldwide practice of AS. Prospective studies showed general agreement in their predefined selection criteria for entry into AS.Retrospective studies showed that patients who were older, with greater comorbidities, worse performance status and smaller tumours were more likely to be managed with AS. The rate of percutaneous renal mass biopsy varied between studies from 2% to 56%. The surveillance protocol was different across all studies in terms of recommended modality and frequency of imaging. Of the 6 studies which had set indications for intervention, these were broadly in agreement. Despite clear criteria for intervention, patient or surgeon preference was still the reason in 11-71% of cases of delayed intervention across 5 studies. This review shows that AS is being applied in a variety of centres worldwide and that key areas of patient selection criteria and surveillance strategy have large similarities. However, the rate of renal mass biopsy and of delayed intervention varies significantly between studies, suggesting the process of diagnosing malignant SRM and decision making whilst on AS are varying in practice. Further research is needed on the diagnosis and characterisation of incidentally found small renal masses (SRM), using imaging and histology, and the natural history of these SRM in order to develop evidence-based active surveillance protocols.

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Section: Search Results Of the International Guidelinesmentioning

confidence: 99%

Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices

Cui

Sullivan

2021

Transl Androl Urol

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Consideration in the management of renal cell carcinoma during the COVID-19 Pandemic

Zéqui¹,

Abreu²

2020

Int. braz j urol.

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Introduction: Recently the COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. Renal cell cancer (RCC) patients configure a heterogenous populations: some of them present indolent cases which can safely have postponed their treatments, others present aggressive tumors, deserving immediate care. These scenarios must be properly identified before a tailored therapeutic choice. Objectives We propose a risk-based approach for patients with RCC, to be used during this unprecedented viral infection time. Materials and Methods: After a literature review focused in COVID-19 and current RCC treatments, we suggest therapeutic strategies of RCC in two sections: surgical approach and systemic therapy, in all stages of this malignance. Results: Patients with cT1a tumors (and complex cysts, Bosniak III/IV), must be put under active surveillance and delayed intervention. cT1b-T2a/b cases must be managed by partial or radical nephrectomy, some selected T1b-T2a ((≤7cm) cases can have the surgery postponed by 60-90 days). Locally advanced tumors (≥cT3 and or N+) must be promptly resected. As possible, minimally invasive surgery and early hospital discharge are encouraged. Upfront cytoreduction, is not recommendable for low risk oligometastatic patients, which must start systemic treatment or even could be put under surveillance and delayed therapy. Intermediate and poor risk metastatic patients must start target therapy and/or immunotherapy (few good responders intermediate cases can have postponed cytoreduction). The recommendation about hereditary RCC syndromes are lacking, thus we recommend its usual care. Local or loco regional recurrence must have individualized approaches. For all cases, we suggest the application of a specific informed consent and a shared therapeutic choice. Conclusion:In the pandemic COVID -19 times, a tailored risk-based approach must be used for a safe management of RCC, aiming to not compromise the oncological outcomes of the patients.

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Comparison of the Results of Therapy for cT1 Renal Carcinoma with Nephron-Sparing Surgery (NSS) vs. Percutaneous Thermal Ablation (TA)

Rusinek

Salagierski

Różański

et al. 2022

JPM

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Implementation of ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) into abdominal cavity diagnostics enabled early detection of cT1 graded renal cancers. According to European Association of Urology (EAU) and Polish urological Association (PUA) recommended method of treatment is sparing resection of renal parenchyma with tumour - nephron-sparing surgery (NSS). In selected cases other methods such as thermal ablation (TA) or cryoablation can be introduced /1/. Objectives: To evaluate the results of treatment of cT1 renal tumours with the use of NSS and TA methods. Material and methods: 140 patients with cT1 renal carcinoma were treated in 2nd Department of Urology of Medical University of Lodz between 2014 and 2017. Neuron-sparing surgery was performed in 56 cases (40%), while percutane-ous thermal ablation (TA) in 84 cases (60%). Demographic data, clinical data (lab results, Charlson index), nephrometry data (tumour size, location, R.E.N.A.L. score) post-operative data (Clavien-Dindo classifica-tion) were investigated. Histopathology results, Fuhrman malignancy grading, as total three-year survival of patients were evaluated. The following methods were used for statistical evaluation: Chi2, Fisher, W Shapiro-Wilk, U Mann-Whitney tests, Kaplan-Meier’s curve and Cox model. The results were displayed in a form of median and upper and lower quartile values (25 – 75%). Results: No statistical differences in gender nor left/right kidney location were observed. Patients, who underwent TA were at average 10 years older and had multiple comorbidities (median age for TA was 79, for NSS 68; median Charlson index for TA was 5 and for NSS was 3). TA patients had lesser haematological values (Hb, Ht). R.E.N.A.L. scoring demonstrated comparable nephrometry in both groups. NSS procedure was open laparotomy without temporary clamping of renal vessels. Surgical margins of resected tumours were negative. TA was performed with Cool-Tip Covidienequipment with the use of Cluster electrode and was ultraso-nography-guided. Post-treatment complications evaluated with the use of Clavien-Dindo classification were slightly more frequent for NSS method. Patients after NSS were discharged at average after 8.5 days and after TA after 3 days. Histopathological type and Fuhrman malignancy grading were comparable in both groups. TA treated patients’ death risk was 9-fold of that observed in NSS treated patients. There was 1 death for each group in perioperative period. Conclusion: 1.NSS was associated with slightly higher side effect rate but resulted in prolonged survival. 2. TA was applied to elderly patients with comorbidities. Despite less invasive treatment this group had poorer/reduced survival. 3. Charlson Comorbidity Index (CCI) and the treatment method were relevant survival factors in patients treated due to cT1 renal cancer tumours.

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Renal cell cancer treatment: an expert panel recommendation from the Latin American cooperative group-genitourinary and the Latin American renal cancer group: focus on surgery

Cited by 3 publications

References 72 publications

Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices

Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices

Consideration in the management of renal cell carcinoma during the COVID-19 Pandemic

Comparison of the Results of Therapy for cT1 Renal Carcinoma with Nephron-Sparing Surgery (NSS) vs. Percutaneous Thermal Ablation (TA)

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