title: Treatment of localised renal cell carcinoma.
abstract: BACKGROUND
  The increasing incidence of localised renal cell carcinoma (RCC) over the last 3 decades and controversy over mortality rates have prompted reassessment of current treatment.
  
  
  OBJECTIVE
  To critically review the recent data on the management of localised RCC to arrive at a general consensus.
  
  
  METHODS
  A Medline search was performed from January 1, 2004, to May 3, 2011, using renal cell carcinoma, nephrectomy (Medical Subject Heading [MeSH] major topic), surgical procedures, minimally invasive (MeSH major topic), nephron-sparing surgery, cryoablation, radiofrequency ablation, surveillance, and watchful waiting.
  
  
  RESULTS
  Initial active surveillance (AS) should be a first treatment option for small renal masses (SRMs) <4 cm in unfit patients or those with limited life expectancy. SRMs that show fast growth or reach 4 cm in diameter while on AS should be considered for treatment. Partial nephrectomy (PN) is the established treatment for T1a tumours (<4 cm) and an emerging standard treatment for T1b tumours (4-7 cm) provided that the operation is technically feasible and the tumour can be completely removed. Radical nephrectomy (RN) should be limited to those cases where the tumour is not amenable to nephron-sparing surgery (NSS). Laparoscopic radical nephrectomy (LRN) has benefits over open RN in terms of morbidity and should be the standard of care for T1 and T2 tumours, provided that it is performed in an advanced laparoscopic centre and NSS is not applicable. Open PN, not LRN, should be performed if minimally invasive expertise is not available. At this time, there is insufficient long-term data available to adequately compare ablative techniques with surgical options. Therefore ablative therapies should be reserved for carefully selected high surgical risk patients with SRMs <4 cm.
  
  
  CONCLUSIONS
  The choice of treatment for the patient with localised RCC needs to be individualised. Preservation of renal function without compromising the oncologic outcome should be the most important goal in the decision-making process.
authors: Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium.
authors: Hein
authors: H
authors: Van Poppel
authors: Frank
authors: F
authors: Becker
authors: Jeffrey A
authors: JA
authors: Cadeddu
authors: Inderbir S
authors: IS
authors: Gill
authors: Gunther
authors: G
authors: Janetschek
authors: Michael A S
authors: MA
authors: Jewett
authors: M Pilar
authors: MP
authors: Laguna
authors: Michael
authors: M
authors: Marberger
authors: Francesco
authors: F
authors: Montorsi
authors: Thomas J
authors: TJ
authors: Polascik
authors: Osamu
authors: O
authors: Ukimura
authors: Gang
authors: G
authors: Zhu
mesh_terms: D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009392:Nephrectomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D016896:Treatment Outcome