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Active surveillance and focal ablation for small renal masses: a better solution for comorbid patients
Piotr Wośkowiak1, Katarzyna Lewicka1, Adrianna Bureta1
1The Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland.
Abstract:
The natural history of small renal masses (SRM) is still not well understood and they are frequently incidentally diagnosed in elderly patients. Therefore, there is a need for less invasive options sparing the patient from the side-effects related to conventional surgical treatment. PubMed and Medline database search was performed to look for new findings on active surveillance and focal therapy for SRM. Sixty-one articles published between 2002 and 2018 were selected for the purpose of the review. There is growing evidence confirming the safety of active surveillance in patients at surgical risk and there appears to be a satisfactory intermediate-term outcome of focal treatment of SRM. In the group of elderly patients with a decreased life expectancy active surveillance appears to be the most appropriate approach. The future of minimally invasive therapy appears bright, especially with the improvement of new imaging modalities.
Insights
Active surveillance and focal therapies offer safer, less invasive options for small renal masses (SRM), especially in elderly patients. These approaches show promising intermediate-term outcomes, improving patient care.
Area of Science:
- Urology
- Oncology
Background:
- Small renal masses (SRM) natural history is poorly understood.
- SRMs are often incidentally discovered in older individuals.
- Conventional surgical treatments for SRM have significant side effects.
Purpose of the Study:
- To review current findings on active surveillance and focal therapy for SRMs.
- To assess the safety and efficacy of less invasive SRM management options.
Main Methods:
- A systematic literature search was conducted using PubMed and Medline.
- Sixty-one articles published between 2002 and 2018 were selected for review.
Main Results:
- Active surveillance is safe for patients at surgical risk.
- Focal treatments demonstrate satisfactory intermediate-term outcomes for SRMs.
- Active surveillance is recommended for elderly patients with reduced life expectancy.
Conclusions:
- Active surveillance and focal therapies are viable, less invasive alternatives to surgery for SRMs.
- Advancements in imaging modalities will likely enhance future minimally invasive treatments for SRMs.
