Management of Small Renal Masses (beta)
Based on guidelines from the American Society of Clinical Oncology.
Active surveillance should be an initial management option for patients who have significant comorbidities and limited life expectancy. Qualifying statement: absolute indication: high risk for anesthesia and intervention or life expectancy <5 years; relative indication: significant risk of end-stage renal disease if treated, small renal mass (<1 cm), or life expectancy <10 years.
Radical nephrectomy for small renal masses should be reserved only for patients who possess a tumor of significant complexity that is not amenable to partial nephrectomy (PN) or where PN may result in unacceptable morbidity even when performed at centers with expertise. Referral to a surgeon and a center with experience in PN should be considered.
Referral to a nephrologist should be considered if chronic kidney disease (estimated glomerular filtration rate <45 mL/min/1.73m2) or progressive CKD develops after treatment, especially if associated with proteinuria.
How strong is the ASCO's recommendation?