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AUA Guideline: Full Kidney Removal Not Necessary for All Kidney Tumors
Date:4/27/2009

tly 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 the following major treatment modalities:

Partial Nephrectomy: Surgical excision by partial nephrectomy is a reference 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 tumor location and solitary kidney.

Thermal Ablation: Thermal ablation (cryoablation or radiofrequency ablation), performed either percutaneously or laparoscopically, 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. Counseling 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 tumor progression is found and the substantial limitations of the current thermal ablation literature.

Active Surveillance: Active surveillance is a reasonable option for the management of localized 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 tumors (>3 to 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
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SOURCE American Urological Association
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