INTRODUCTION: The aim of this article is to generally describe the roles of main surgical modalities in treatment of renal tumors, especially in the CT1a category in clinical practice. Surgical modalities include the following: laparoscopic or open resection (LR, OR) and laparoscopic or open nephrectomy (LN, ON). Representation of these methods has been changing over years due to improved operative skills and equipment and due to a shift of tumors to the lower T categories. MATERIAL AND METHODS: The sources of data were surgeries performed for renal tumors at the institution of the main author during the period 2002 to III/2016, reaching a total of 2204 cases (546 ONs, 647 LNs, 668 ORs and 343 LRs). Patients indicated for percutaneous ablative therapy or active surveillance were not included. RESULTS: During the whole period, the proportions of methods were: ONs 24.8%, LNs 29.4%, ORs 30.3%, LRs 15.6%. But during the years 2014 - III/2016, these changed to 12.6%:26.3%:31.6%:29.4% (in cT1a 1.7%:8.3%:37.8%:52.2%). Category cT1a constitutes in the years 2007 - III/2016 41.3%, in 2014 - III/2016 50.9%. CONCLUSIONS: Resections and minimally invasive approaches are being performed more frequently and are the preferred methods in surgical treatment of kidney tumors. Resection is now indicated in about 60% of cases (open vs. laparoscopic resection are used nearly equally with a slight tendency for laparascopic predomination). In the cT1a category (amounting to approximately 50% of all surgically treated tumors), resection is possible in about 85-90% of cases.

Department of Pathology National University Health System Singapore Singapore

University Hospital Department of Pathology Plzeň Czech Republic

University Hospital Department of Urology Plzeň Czech Republic

See more in PubMed

Capitanio U, Montorsi F. Renal cancer. Lancet. 2016;387:894–906. PubMed

Ljungberg B, Bensalah K, Canfield S, et al. EAU Guidelines on Renal Cell Carcinoma: 2014 Update. Eur Urol. 2015;67:913–924. PubMed

MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol. 2012;61:972–993. PubMed

Harris KT, Ball MW, Gorin MA, Allaf ME, Pierorazio PM. Outcomes of partial nephrectomy in patients who meet percutaneous ablation criteria. Cent European J Urol. 2015;68:132–136. PubMed PMC

Ljungberg B, Hedin O, Lundstam S, et al. Nephron Sparing Surgery Associated With Better Survival Than Radical Nephrectomy in Patients Treated for Unforeseen Benign Renal Tumors. Urology. 2016;93:117–123. PubMed

Pierorazio PM, Johnson MH, Patel HD, et al. Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. J Urol. 2016 doi: 10.1016/j.juro.2016.04.081. [Epub ahead of print] PubMed DOI PMC

Van Poppel H, Becker F, Cadeddu JA, et al. Treatment of localised renal cell carcinoma. Eur Urol. 2011;60:662–672. PubMed

Volpe A, Cadeddu JA, Cestari A, et al. Contemporary management of small renal masses. Eur Urol. 2011;60:501–515. PubMed

Fernando A, Fowler S, O'Brien T. Nephron-sparing surgery across a nation-outcomes from the British Association of Urological Surgeons 2012 national partial nephrectomy audit. BJU Int. 2016;117:874–882. PubMed

Vigneswaran HT, Lec P, Brito J, Turini G, Pareek G, Golijanin D. Partial Nephrectomy for Small Renal Masses: Do Teaching and Nonteaching Institutions Adhere to Guidelines Equally? J Endurol. 2016;30:714–721. PubMed

Aben KKH, Osanto S, Hulsbergen-van de Kaa CA, Soetekouw PM, Stemkens D, Bex A. Adherence to guideline recommendations for management of clinical T1 renal cancers in the Netherlands: a population-based study. World J Urol. 2016;34:1053–1068. PubMed PMC

Amer T, Biju RD, Hutton R, et al. Laparoscopic nephrectomy-Pfannenstiel or expanded port site specimen extraction: a systematic review and meta-analysis. Cent European J Urol. 2015;68:322–329. PubMed PMC

Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016;70:93–105. PubMed

Bianchi M, Becker A, Abdollah F, et al. Rates of open versus laparoscopic and partial versus radical nephrectomy for T1a renal cell carcinoma: a population-based evaluation. Int J Urol. 2013;20:1064–1071. PubMed

Hora M, Eret V, Ürge T, et al. Results of laparoscopic resection of kidney tumor in everyday clinical practice. Cent European J Urol. 2009;62:160–166.

Kates M, Badalato G, Pitman M, McKiernan J. Persistent overuse of radical nephrectomy in the elderly. Urology. 2011;78:555–559. PubMed

Breau RH, Crispen PL, Jenkins SM, Blute ML, Leibovich BC. Treatment of patients with small renal masses: a survey of the American Urological Association. J Urol. 2011;185:407–413. PubMed

Kim SP, Shah ND, Weight CJ, et al. Contemporary trends in nephrectomy for renal cell carcinoma in the United States: results from a population based cohort. J Urol. 2011;186:1779–1785. PubMed

Hora M, Babjuk M, Brodák M, Tomáš H, Ladislav J, Krhut J, et al. Key urological surgical procedures in the Czech Republic in period 2009-2014. Czes Urol. 2016;20:135–140.

Ljungberg B, Gudmundsson E, Christensen S, Lundstam S. Practice patterns for the surgical treatment of T1 renal cell carcinoma: a nationwide population-based register study. Scandin J Urol. 2014;48:445–452. PubMed

Smaldone MC, Kutikov A, Egleston B, et al. Assessing performance trends in laparoscopic nephrectomy and nephron-sparing surgery for localized renal tumors. Urology. 2012;80:286–291. PubMed PMC

Cooperberg MR, Mallin K, Kane CJ, Carroll PR. Treatment trends for stage I renal cell carcinoma. J Urol. 2011;186:394–399. PubMed

Hora M, Klecka J, Hes O, Ferda J, Urge T. [Miniinvasive laparoscopic or retroperitoneoscopic radical nephrectomy for the parenchymal tumor] Rozhl Chir. 2005;84:246–252. PubMed

Millman AL, Pace KT, Ordon M, Lee JY. Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumors. Can Urol Assoc. 2014;8:183–189. PubMed PMC

Patel HD, Mullins JK, Pierorazio PM, et al. Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol. 2013;189:1229–1235. PubMed

Klatte T, Ficarra V, Gratzke C, et al. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy. Eur Urol. 2015;68:980–992. PubMed PMC

Sobczyński R, Golabek T, Przydacz M, et al. Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report. Cent European J Urol. 2015;68:311–317. PubMed PMC

Verhoest G, Couapel JP, Oger E, et al. Safety and Feasibility of Laparoscopic Nephrectomy for Big Tumors (≥10 cm): A Retrospective Multicentric Study. Clin Genitourin Cancer. 2016;14:e335–340. PubMed

Gill IS, Metcalfe C, Abreu A, et al. Robotic Level III Inferior Vena Cava Tumor Thrombectomy: Initial Series. J Urol. 2015;194:929–938. PubMed PMC

Wang M, Zhang J, Niu Y, Xing N. Feasibility of Pure Conventional Retroperitoneal Laparoscopic Radical Nephrectomy With Level II Vena Caval Tumor Thrombectomy. Urology. 2016;90:101–105. PubMed