Nephron-sparing surgery and percutaneous biopsies in renal-cell carcinoma: a global impression among endourologists.
OBJECTIVE
On the one hand, nephron-sparing surgery (NSS) in small renal tumors is a safe and effective alternative to radical nephrectomy. On the other hand, the role of preoperative percutaneous needle biopsies (PNB) remains controversial. The purpose of this study was to evaluate the global current use of NSS in the treatment of renal-cell carcinoma (RCC) and the use of PNB among endourologists.


METHODS
One thousand questionnaires were distributed during the 23rd World Congress of Endourology and SWL. Six questions regarding NSS and two questions regarding PNB were presented. Two hundred twenty-two questionnaires were returned.


RESULTS
Of the respondents, 86.6% perform NSS for small renal tumors, whereas 13.4% perform only radical nephrectomies; 7.5% will consider NSS only in patients with a solitary kidney, and 0.5% will never consider NSS. The techniques for NSS, in descending order of preference, are partial nephrectomy, enucleation, cryoablation, radiofrequency ablation, and high-intensity focused ultrasound. The mean and maximum diameter of the tumor in patients with a normal contralateral kidney for which the urologists perform NSS is 4.0 cm. For a centrally located tumor, NSS is an option for 27.2% of the respondents. Regarding PNB in patients with suspicion of RCC, 55.9% of respondents never obtain renal biopsies in the preoperative assessment and 41.8% obtain them only in rare cases. The majority (90%) prefer histologic over cytologic biopsies.


CONCLUSIONS
Nephron-sparing surgery is evolving to a global worldwide standard treatment for small renal tumors. Percutaneous needle biopsy remains a highly debated procedure.
Kümmerlin
Intan P E D
IP
Department of Urology, Academic Medical Center, University of Amsterdam, The Netherlands. i.p.kummerlin@amc.uva.nl
Borrego
Jaime
J
Wink
Margot H
MH
Van Dijk
Marleen M
MM
Wijkstra
Hessel
H
de la Rosette
Jean J M C H
JJ
Laguna
M Pilar
MP
D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D019538:Health Care Surveys; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D009399:Nephrons / Q000601:surgery; D010820:Physicians; D011795:Surveys and Questionnaires; D014572:Urology / Q000379:methods*