Surgical Management of Small Renal Masses.

摘要

Introduction: Detection of small renal masses is increasing. We reviewed trends in presentation and surgical management of renal tumors at Mayo Clinic, Rochester and we surveyed American Urological Association (AUA) members to determine factors that influence management of these patients.;Methods: Renal tumor patients treated with radical or partial nephrectomy for a sporadic, unilateral, localized, solid renal mass between 1997 and 2006 were evaluated. Clinicopathologic characteristics were abstracted from the medical records. In June 2009, AUA members were solicited to complete an online survey. Respondents were asked their preferred treatment for 8 cases and 3 index patients. In each case, computed tomographic axial and schematic coronal images were provided.;Results: At Mayo Clinic, 1,740 patients were identified and reviewed. During the study period, gender (66% male), age (mean 63; SD 12.4 years), pre-operative renal function (mean GFR 62; SD 16.4 ml/min/m2), BMI (mean 30; SD 5.7 kg/m2) and tumor size (mean 5.2; SD 3.5 cm) have not changed dramatically. However, over time, partial nephrectomy has been used with increasing frequency. As of 2006, 88% of patients with renal tumors up to 4 cm had a partial nephrectomy. In the renal mass survey, 759 active urologists participated. Tumor size (OR 8.4; 95%CI 7.1 - 10.1), tumor depth (OR 19.2; 95%CI 14.8 - 25.0) and tumor location (OR 24.0; 95%CI 18.1 - 31.8) are markedly associated with preference for radical instead of partial nephrectomy. Fellowship trained urologists (OR 0.4; 95%CI 0.2 - 0.6) and urologists at academic hospitals (OR 0.6; 95%CI 0.4 - 0.9) are less likely to choose radical nephrectomy. Respondents are more likely to choose surveillance instead of treatment of an older patient (OR 2.7; 95%CI 2.1 - 3.6) or in a patient with comorbid disease (OR 10.0; 95%CI 8.0 -12.4).;Conclusion: While patient characteristics have remained relatively stable, partial nephrectomy now dominates surgical treatment of renal masses at Mayo Clinic. Among AUA members, considerable heterogeneity was observed in management of patients with a small renal tumor. Several factors explaining these differences were identified. Future studies are needed to characterize the association between these factors and patient outcomes.