Renal Mass and Localized Renal Cancer: AUA Guideline

Steven Campbell, Robert G. Uzzo, Mohamad E. Allaf, Eric B. Bass, Jeffrey A. Cadeddu, Anthony Chang, Peter E. Clark, Brian J. Davis, Ithaar H. Derweesh, Leo Giambarresi, Debra A. Gervais, Susie L. Hu, Brian R. Lane, Bradley C. Leibovich, Philip M. Pierorazio

Research output: Contribution to journalArticle

418 Scopus citations

Abstract

Purpose This AUA Guideline focuses on evaluation/counseling and management of adult patients with clinically localized renal masses suspicious for cancer, including solid-enhancing tumors and Bosniak 3/4 complex-cystic lesions. Materials and Methods Systematic review utilized research from the Agency for Healthcare Research and Quality and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A/B/C (Strong/Moderate/Conditional Recommendations, respectively) with additional statements presented as Clinical Principles or Expert Opinions. Results Great progress has been made since the previous guidelines on management of localized renal masses were released (2009). The current guidelines provide updated, evidence-based recommendations regarding evaluation/counseling of patients with clinically localized renal masses, including the evolving role of renal mass biopsy. Given great variability of clinical, oncologic and functional characteristics, index patients are not utilized and the panel advocates individualized counseling/management. Management options (partial nephrectomy/radical nephrectomy/thermal ablation/active surveillance) are reviewed including recent data about comparative effectiveness and potential morbidities. Oncologic issues are prioritized while recognizing that functional outcomes are of great importance for survivorship for most patients with localized kidney cancer. A more restricted role for radical nephrectomy is recommended following well-defined selection criteria. Priority for partial nephrectomy is recommended for clinical T1a lesions, along with selective use of thermal ablation, particularly for tumors ≤3.0 cm. Important considerations for shared decision-making about active surveillance are explicitly defined. Conclusions Several factors should be considered during counseling/management of patients with clinically localized renal masses, including general health/comorbidities, oncologic potential of the mass, pertinent functional issues and relative efficacy/potential morbidities of various management strategies.

Original languageEnglish (US)
Pages (from-to)520-529
Number of pages10
JournalJournal of Urology
Volume198
Issue number3
DOIs
StatePublished - Sep 1 2017
Externally publishedYes

Keywords

  • ablation techniques
  • kidney diseases
  • kidney neoplasms
  • nephrectomy
  • watchful waiting

ASJC Scopus subject areas

  • Urology

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    Campbell, S., Uzzo, R. G., Allaf, M. E., Bass, E. B., Cadeddu, J. A., Chang, A., Clark, P. E., Davis, B. J., Derweesh, I. H., Giambarresi, L., Gervais, D. A., Hu, S. L., Lane, B. R., Leibovich, B. C., & Pierorazio, P. M. (2017). Renal Mass and Localized Renal Cancer: AUA Guideline. Journal of Urology, 198(3), 520-529. https://doi.org/10.1016/j.juro.2017.04.100