title: Small renal masses initially managed using active surveillance: results from a retrospective study with long-term follow-up.
abstract: BACKGROUND
  The purpose of this study was to provide outcomes of patients managed using active surveillance (AS) for small renal masses (SRMs).
  
  
  METHODS
  We retrospectively reviewed data of 62 patients diagnosed with 64 contrast enhancing SRMs suspicious for renal cell carcinoma. We evaluated the differences between patients who remained on AS and those who underwent delayed surgical intervention.
  
  
  RESULTS
  The mean age of patients was 75 years and the mean follow-up was 91.5 months. The median tumor size and the median estimated tumor volume were 2.6 cm and 8.7 cm(3), respectively. The median linear growth rate and the median volumetric growth rate were 0.7 cm/y and 8.8 cm(3)/y, respectively. The mean linear and volumetric growth rates of the group of patients who underwent surgery was higher than in those who remained on surveillance (1.9 vs. 0.4 cm/y and 16.1 vs. 4.6 cm(3)/y, respectively; P < .001).
  
  
  CONCLUSIONS
  Most SRMs show an indolent course, with low metastatic potential. Faster linear and volumetric growth rates could be the expression of malignant disease, thus suggesting the need for a delayed surgical intervention. AS is a reasonable option for the management of SRMs in properly selected patients with low life expectancy.
authors: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: Eugenio
authors: E
authors: Brunocilla
authors: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: mark.borghesi@gmail.com.
authors: Marco
authors: M
authors: Borghesi
authors: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: Riccardo
authors: R
authors: Schiavina
authors: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: Livia
authors: L
authors: Della Mora
authors: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: Hussam
authors: H
authors: Dababneh
authors: Department of Nephrology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: Gaetano
authors: G
authors: La Manna
authors: Department of Radiology, M.F. Toniolo Hospital, Bologna, Italy.
authors: Carlo
authors: C
authors: Monti
authors: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: Giuseppe
authors: G
authors: Martorana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Growth rate; Nephrectomy; Nephron-sparing surgery; Renal cell carcinoma; Small renal tumors