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AUA Guideline: Radical Nephrectomy Not Necessary for All Kidney Tumours LINTHICUM, Md -- May 4, 2009 -- Radical nephrectomy is not the best treatment for most small kidney tumours because it puts patients at risk for chronic kidney disease and cardiovascular disease, according to a new clinical guideline issued by the American Urological Association (AUA). The guideline will be published in The Journal of Urology later this year. Nephron-sparing treatments, such as partial nephrectomy, thermal ablation, and active surveillance, minimise these risks and are viable options for patients with early-stage kidney tumours. This is the first time that the AUA has released official guidelines for the management of patients with kidney cancer. The guideline is focused on the management of patients with early-stage renal masses, which has become controversial in the past few years. Detection of clinical stage 1 (< 7.0 cm) renal masses has increased in frequency and is now a common clinical scenario for the practicing urologist. Of these tumours, 20% are benign, 60% are indolent kidney cancer, and only about 20% are potentially aggressive kidney cancer at the time of diagnosis. Kidney cancer is the most lethal of the commonly diagnosed urologic malignancies, but small, clinically confined tumours are very heterogeneous, and most do not require radical nephrectomy. "There are now several options available for the treatment of early stage kidney cancer," said guideline coauthor Steven C. Campbell, MD, Cleveland Clinic, Cleveland, Ohio. "Radical nephrectomy is currently greatly overutilised. 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 the following major treatment modalities: · Partial Nephrectomy: This is the standard for the management of clinical T1 renal masses, whether for imperative or elective indications, given the importance of preservation of renal function and avoidance of chronic kidney disease. In general, open partial nephrectomy is preferred for complex cases such as hilar tumour location and solitary kidney. · Thermal Ablation: This is an appealing treatment option for the patient at high surgical risk who wants active treatment and accepts the need for long-term radiographic surveillance. Counselling about thermal ablation should include a balanced discussion of the increased risk of local recurrence when compared to surgical excision, the potential need for reintervention, the potential for difficult surgical salvage if tumour progression is found and the substantial limitations of the current thermal ablation literature. · Active Surveillance: This is a reasonable option for the management of localised renal masses that should be a primary consideration for patients with decreased life expectancy or extensive comorbidities that would increase the risks of intervention. However, more aggressive or larger tumours (> 3cm - 4 cm) should be managed in a proactive manner, if possible. · Radical Nephrectomy: Radical nephrectomy is still occasionally required. A laparoscopic approach should be considered because it is associated with a more rapid recovery profile. The Guideline Panel also addressed the following novel treatment modalities: high-intensity focused ultrasound, radiosurgery, microwave thermotherapy; laser interstitial thermal therapy; and pulsed cavitational ultrasound. SOURCE American Urological Association E-mail this page to a friend or colleague! To print, use this version