The management of small renal masses: what is likely to change?

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Increasing discovery of small renal masses (SRMs) due to advanced imaging techniques.
• SRMs present a management challenge, necessitating a review of current and future strategies.
• The expanding role of percutaneous biopsies, active surveillance, and ablative therapies in SRM management.

Purpose of the Study:

• To present the state-of-the-art management of small renal masses (SRMs).
• To explore future directions in the treatment of SRMs.
• To compare different treatment modalities for SRMs, including surgical and non-surgical options.

Main Methods:

• Review of recent publications on small renal mass (SRM) management.
• Analysis of data on percutaneous biopsy, active surveillance, and ablative therapies (cryotherapy, radiofrequency ablation).
• Comparison of oncological and functional outcomes for open, laparoscopic, and robot-assisted partial nephrectomy (PN).

Main Results:

• Percutaneous biopsies have limitations, with up to 30% failing to yield a diagnosis and a risk of underestimating tumor grade.
• Active surveillance is suitable for patients with limited life expectancy or comorbidities; metastatic progression is rare (approx. 1%).
• Ablative therapies offer an alternative for select patients but have higher local progression rates than partial nephrectomy (PN).
• Robot-assisted PN shows promising perioperative outcomes and a shorter learning curve compared to laparoscopy, though long-term oncological data are still maturing.

Conclusions:

• Partial nephrectomy (PN) is the recommended curative treatment for SRMs, with robotic assistance gaining traction.
• While ablative therapies and active surveillance have roles, PN offers superior oncological control for eligible patients.
• The increasing adoption of robotic technology is expected to influence the future management of SRMs.