Changing management of organ-confined renal masses.
OBJECTIVE
Rapid evolution of laparoscopic and ablative techniques is changing the approach to renal masses. We evaluated our approach to managing renal masses in light of newly available technology.


METHODS
The records for all patients who underwent treatment for a renal mass between January 2000 and July 2002 at UT Southwestern Medical Center were reviewed for patient demographics, operative details, and pathology results. There were 180 patients with 190 masses. Of the 190 masses, 97 were <4 cm, 47 were between 4 and 7 cm, and 46 were >7 cm.


RESULTS
Most tumors >7 cm were managed with open radical nephrectomy (RN). For patients with masses between 4 and 7 cm, the majority were treated with laparoscopic RN, while 21% were treated by open partial nephrectomy (PN). Tumors <4 cm were treated with the widest variety of approaches. Open PN was the most commonly utilized, followed by laparoscopic RN and percutaneous ablation. The number of laparoscopic and percutaneous ablative procedures increased significantly with time, from none in the first year to 13% (7/55) and 29% (16/55) in the last year, respectively. Benign pathology was found in 20%, 17%, and none of lesions <4, 4 to 7, and >7 cm, respectively.


CONCLUSIONS
The addition of laparoscopy and ablative technologies has increased the treatment options for patients with renal masses. We propose a treatment algorithm that incorporates ablative technologies and favors parenchyma-sparing approaches for small lesions.
Lotan
Yair
Y
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
Duchene
David A
DA
Cadeddu
Jeffrey A
JA
Sagalowsky
Arthur I
AI
Koeneman
Kenneth S
KS
D000465:Algorithms; D001837:Body Weights and Measures; D017115:Catheter Ablation / Q000379:methods* / Q000639:trends; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery* / Q000628:therapy; D010535:Laparoscopy / Q000379:methods / Q000639:trends; D009392:Nephrectomy / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome