Conservative management of renal masses in the elderly: our experience.
OBJECTIVE
To analyse a group of patients with clinically and radiologically detected renal neoplasms who were conservatively treated for various reasons. The patients were followed-up radiologically and intervened only if symptomatic. The natural progression of these masses and also a brief review of the literature is done.


METHODS
The series was collected retrospectively from the case-notes of patients coded for renal neoplasms. Of the 13 patients followed up conservatively, eight were deferred surgery in view of their age (mean age-83.25 years), one patient had a single kidney, two were unwilling for surgery and two had severe co-morbidities which made them unfit for surgery.


RESULTS
The mean age at diagnosis was 80.4 years (median-82; range 66-88). Seven females and six males were followed up for a mean and median follow-up of 38.38 and 34 months respectively (range-19 to 105 months). Six patients died during follow-up (mean-41.57 months). The average longest dimension at diagnosis and when last reviewed were 5.01 cm and 5.57 cm. However, only one of these died due to metastasis which developed during follow-up and two had to be angio-embolised for hematuria. The average rate of growth along the longitudinal dimension was 0.17 cm/year while the average change in volume was 11.97 cc/year.


CONCLUSIONS
Malignant renal neoplasms grow at a relatively slow rate. Without tumour growth the risk of metastasis appears limited. Thus expectant management can be considered as an alternative for a selected group of patients who are either unwilling or unfit or high risk for surgery.
Fernando
Herman S
HS
Department of Urology, Scarborough General Hospital, Scarborough, Yorkshire, UK. herman.fernando@yahoo.co.uk
Duvuru
Sudhir
S
Hawkyard
Simon J
SJ
D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D006801:Humans; D007680:Kidney Neoplasms / Q000628:therapy*