Active surveillance provides a viable alternative to surgery for small kidney masses

October 17, 2012

Active surveillance of small kidney masses is a safe and effective alternative to immediate surgery, with similar overall and cancer specific survival rates, according to a study published in the November issue of the urology journal BJUI.

The technique is primarily used to treat who have complex health issues or decline surgery. But researchers from the Department of Urology at Churchill Hospital, Oxford, UK, say that the results of their study suggest that active surveillance could safely be extended to other selected patients.

"The incidence of kidney cancer has been increasing in Europe and the USA since the 1980s and the use of more sophisticated imaging techniques means that smaller masses of less than 4cm are being picked up at earlier stages" says lead author Dr Nilay Patel.

"This has led to an increased rate of surgery for small kidney masses, but the benefits of this remain unclear. Conflicting reports on improvements in for over the last few years suggest that increased detection may not necessarily be improving survival rates for patients with smaller tumours inside their kidney."

A total of 202 patients with 234 small renal masses of less than 4cms inside their kidney - classified as T1a – were identified.

Ninety were managed with (where only the diseased part of the kidney is removed), 41 with a (where the entire kidney is removed) and 71 with active surveillance (where patients are monitored for ).

Key findings included:

  • Over a median follow-up of 34 months, the mean growth rate of the kidney masses in patients who were under active surveillance was 0.21cm. However, 53 per cent of the small renal masses in these patients showed negative or zero growth.
  • No statistically significant differences were observed in overall and cancer-specific survival rates for patients who were under active surveillance or received partial or radical nephrectomy.
  • The overall survival rates were 83 per cent for active surveillance, 80 per cent for radical nephrectomy and 90 per cent for partial nephrectomy.
  • The cancer specific were 99 per cent for active surveillance, 93 per cent for radical nephrectomy and 97 per cent for partial nephrectomy.
"Our research suggests that active surveillance of small kidney masses offers similar cancer outcomes to radical or partial surgery in the short and intermediate term" says Dr Patel.

"The results of this study support the need for a multicentre, prospective randomised trial to compare how active surveillance and surgery compare when it comes to managing such patients."

More information: Active surveillance of small renal masses offers short-term oncological efficacy equivalent to radical and partial nephrectomy. Patel et al. BJUI. 110, pp1270. (November 2012). doi:10.1111/j.1464-410X.2012.11130.x

Related Stories

Kidney-preserving surgery saves bone health

August 5, 2011

Researchers at the University of California, San Diego School of Medicine have shed new light on how surgery impacts both chronic kidney disease and bone health, particularly in women. For the first time, their findings point ...

Recommended for you

A recipe for long-lasting livers

April 22, 2015

People waiting for organ transplants may soon have higher hopes of getting the help that they need in time. Researchers at the RIKEN Center for Developmental Biology have developed a new technique that extends the time that ...

Surgeon to offer ideas on a way to do human head transplants

February 26, 2015

Sergio Canavero of the Turin Advanced Neuromodulation Group has made it known that he intends to announce at this summer's American Academy of Neurological and Orthopedic Surgeons meeting, that he believes he has put together ...

New tool helps guide brain cancer surgery

July 3, 2014

A tool to help brain surgeons test and more precisely remove cancerous tissue was successfully used during surgery, according to a Purdue University and Brigham and Women's Hospital study.

New imaging technique sharpens surgeons' vision

February 11, 2014

Which superhuman power would you choose for help on the job? For Dr. Julie Margenthaler, it's a technology that brings to mind X-ray vision, used for the first time Monday during an operation to remove a patient's lymph node.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.