In patients with small renal tumors confined to the kidneys, close, active monitoring, as opposed to immediate surgery, is associated with low rates of tumor growth or death, according to a study published in the Journal of Urology (2014; doi:10.1016/j.juro.2014.03.038).
Although surgical excision of tumors remains the standard of care for renal tumors that have not yet spread (localized), the risk of complications in elderly or ill patients may outweigh the benefits of surgery. The study suggests that actively monitoring renal tumors in some patients may prove a safer option than immediate surgery.
The incidence of kidney cancer in the United States has been increasing for two decades, with the trend partly attributed to the introduction of abdominal imaging studies such as CT scans or MRIs in the 1980s. However, death rates due to renal cell carcinoma (kidney cancer) have not decreased, indicating that surgery may be of little or no benefit to some patients.
“We are beginning to better understand the behavior of tumors that grow on the kidneys,” said the study’s lead investigator, Reza Mehrazin, MD, assistant professor of Urology at the Icahn School of Medicine at Mount Sinai in New York, New York. “In some patients, particularly those who are considered elderly or ‘high risk,’ we are now more likely able to delay surgery, sometimes indefinitely.”
In cases which are likely to result in surgery, it is important that urologists understand the natural history of renal tumors. If surgery does prove necessary, minimally invasive surgery using robotic tools may be possible. For example, a robotic partial nephrectomy offers the surgeon enhanced visualization and precision during the procedure, which translates to significantly less blood loss. Moreover, the incisions are smaller and result in less pain and shorter recovery time and hospital stay.
“Patients diagnosed with renal tumors have more options than ever before,” said Mehrazin. “Surgery is not always the best solution. It is vital that patients consult with their urologists to explore all options and make the best treatment decision for that particular case.”