Management of Small Renal Masses

Published online January 17, 2017, DOI: 10.1200/JCO.2016.69.9645

Antonio Finelli, Nofisat Ismaila, Bill Bro, Jeremy Durack, Scott Eggener, Andrew Evans, Inderbir Gill, David Graham, William Huang, Michael A.S. Jewett, Sheron Latcha, William Lowrance, Mitchell Rosner, Bobby Shayegan, Houston R. Thompson, Robert Uzzo, and Paul Russo

Purpose

To provide recommendations for the management options for patients with small renal masses (SRMs).

Methods

By using a literature search and prospectively defined study selection, we sought systematic reviews, meta-analyses, randomized clinical trials, prospective comparative observational studies, and retrospective studies published from 2000 through 2015. Outcomes included recurrence-free survival, disease-specific survival, and overall survival.

Results

Eighty-three studies, including 20 systematic reviews and 63 primary studies, met the eligibility criteria and form the evidentiary basis for the guideline recommendations.

Recommendations

On the basis of tumor-specific findings and competing risks of mortality, all patients with an SRM should be considered for a biopsy when the results may alter management. Active surveillance should be an initial management option for patients who have significant comorbidities and limited life expectancy. Partial nephrectomy (PN) for SRMs is the standard treatment that should be offered to all patients for whom an intervention is indicated and who possess a tumor that is amenable to this approach. Percutaneous thermal ablation should be considered an option if complete ablation can reliably be
achieved. Radical nephrectomy for SRMs should only be reserved for patients who possess a tumor of significant complexity that is not amenable to PN or for whom PN may result in unacceptable morbidity even when performed at centers with expertise. Referral to a nephrologist should be considered if chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73 m²) or progressive chronic kidney disease occurs after treatment, especially if associated with proteinuria.

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