AUA guideline: Radical nephrectomy not best option for most small tumors

Nephron-sparing treatments, including partial nephrectomy, thermal ablation, and active surveillance, minimize risk of chronic kidney disease and cardiovascular disease and are viable options for patients with early-stage kidney tumors, according to a new clinical guideline issued by AUA. The guideline was released during the 2009 AUA annual meeting in Chicago.

Detection of clinical stage 1 renal masses has increased in frequency and is now a common clinical scenario for the practicing urologist. Of these tumors, 20% are benign, 60% are indolent kidney cancer, and only about 20% are potentially aggressive kidney cancer at the time of diagnosis. Because radical nephrectomy puts patients at risk for chronic kidney disease and cardiovascular disease, it does not appear to be the best treatment for most small kidney tumors.

"There are now several options available for the treatment of early-stage kidney cancer," said Steven Campbell, MD, PhD, co-chair of the panel that developed the guideline, the first of its kind from AUA. "Radical nephrectomy is currently greatly overutilized. Whenever possible, it is important to preserve renal function by taking a nephron-sparing approach."

In preparing the guideline, the panel assessed the efficacy of these major treatment modalities: partial nephrectomy, thermal ablation, active surveillance, and radical nephrectomy. The full guideline, which includes the panel’s recommendations about each of these modalities and others, is available on the AUA web site (www.auanet.org).