Tumor enucleation for small renal masses
Nicholas A Laryngakis1, Thomas J Guzzo
1Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Purpose Of Review:
The incidence of renal cell carcinoma and the detection of incidental small renal masses are rising. Urologists are faced with difficult management decisions on how to treat patients with small renal masses. Traditionally, the treatment of suspicious renal masses was radical nephrectomy. However, nephron-sparing surgery is the standard of care, when possible, because of the risk of renal insufficiency associated with radical nephrectomy.
Recent Findings:
A large breadth of data have shown that partial nephrectomy has equivalent oncologic outcomes compared to radical nephrectomy. Recently, attempts to further spare renal parenchyma and perform nephron-sparing surgery in anatomically difficult scenarios have led to the development of the enucleation technique. Enucleation is performed by following the natural plane between the peritumor pseudocapsule and the renal parenchyma. This emerging technique was met with skepticism and concern for incomplete tumor removal. However, studies comparing enucleation and partial nephrectomy to date have revealed equivalent oncologic outcomes.
Summary:
There has been a greater acceptance of tumor enucleation as a safe alternative for renal masses which are locally confined on preoperative imaging, easily delineated intraoperatively, and do not appear to grossly invade beyond the pseudocapsule.
Insights
Tumor enucleation offers oncologic outcomes equivalent to partial nephrectomy for select renal masses. This nephron-sparing technique is increasingly accepted for localized renal cell carcinoma, preserving kidney function.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Rising incidence of renal cell carcinoma and incidental small renal masses presents management challenges.
- Radical nephrectomy was traditional, but nephron-sparing surgery is preferred due to risks of renal insufficiency.
- Partial nephrectomy is the established standard for localized renal masses.
Purpose of the Study:
- To review the oncologic outcomes of tumor enucleation compared to partial nephrectomy for small renal masses.
- To assess the safety and efficacy of enucleation in anatomically challenging scenarios.
- To evaluate the growing acceptance of enucleation as a nephron-sparing surgical option.
Main Methods:
- Review of existing data comparing partial nephrectomy and tumor enucleation.
- Analysis of oncologic outcomes, including recurrence and metastasis rates.
- Evaluation of surgical technique focusing on the plane between pseudocapsule and parenchyma.
Main Results:
- Partial nephrectomy demonstrates equivalent oncologic outcomes to radical nephrectomy.
- Tumor enucleation shows equivalent oncologic outcomes to partial nephrectomy.
- Enucleation is performed by dissecting along the natural plane, sparing renal parenchyma.
Conclusions:
- Tumor enucleation is a safe and effective alternative for localized renal masses.
- Acceptance of enucleation is increasing for masses confined by preoperative imaging and intraoperative delineation.
- Enucleation preserves renal parenchyma and function, offering a valuable nephron-sparing option.
