Enucleation found efficacious for small renal tumors

Key Points

Vienna, Austria-Five-year follow-up of older patients with renal tumors less than 3 cm shows that minimally invasive surgery with tumor enucleation yields less tumor progression than either percutaneous radiofrequency ablation (PRA) or active surveillance, say Italian researchers.

"The message of our study is that open minimally invasive tumor enucleation is the best therapeutic option for older patients with small renal tumors," said first author Maurizio A. Brausi, MD, professor and chairman of urology at AUSL Modena Hospital, Modena, Italy.

Mean diameter of the tumors in the enucleation, PRA, and active surveillance groups was 2.1 cm, 2.5 cm, and 2.2 cm respectively, and mean follow-up was 60.1, 62.1, and 56.3 months.

In the first group, two out of 27 patients (7.4%) died of other causes; ie, pulmonary embolism and cardiac failure. Twenty-five patients (92.6%) had no tumors and no evidence of disease, said Dr. Brausi, who presented the study at the European Association of Urology annual congress in Vienna, Austria.

In the PRA group, 10 of 24 patients (42%) died of other causes, three (12.5%) had progressed with an increase in tumor diameter of 5 mm, two (8.3%) had a complete remission, and 17 (70.1%) had stable disease.

Two out of 22 patients on active surveillance died of other causes, while three patients experienced tumor progression, with increases of 0.5 cm, 0.6 cm, and 2 cm in diameter, respectively. The rest of the patients (77%) had stable disease.

"Our conclusion is that tumor enucleation is the best option for this category of patients since, in contrast to PRA and active surveillance, it gives no tumor progression," said Dr. Brausi.

Not a randomized trial

Some of the discussion of the study at the meeting centered on its perceived limitations.

"This is not a randomized trial," said J. Alfred Witjes, MD, PhD, of Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. "The three groups of patients are different. Obviously, the first group is the best fit, even if they have ASA 3/4, since they are ready for surgery. The patients receiving PRA have more comorbidities, while the patients on active surveillance also can be considered for surgery."

Dr. Brausi agreed that this was not a randomized trial and also concurred with Dr. Witjes' point that patients are unlikely to die from their small renal tumors.

"There is, however, a higher risk of tumor progression with PRA and active surveillance, and our policy is therefore to treat with laparoscopic surgery," Dr. Brausi said.