Kidney Lesions
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Surgical Resection of Renal Cell Carcinoma
The primary treatment for renal cell carcinoma (RCC) is surgical resection (1, 2, 3, 4, 5, 6). The degree of surgery may be tailored to the extent of disease, and varies from partial nephrectomy, to total nephrectomy, to extended total nephrectomy with resection of nodal metastases, to metastectomy for limited hematogenous-borne disease. All of these approaches up to and including metastectomy have curative potential in selected RCC patients, though the chance of extended survival is significantly diminished in the presence of nodal or distant metastases (1, 2, 3, 4, 5, 6). Because long-term survivors are seen at all stages of RCC, aggressive treatment of primary, regional and limited metastatic disease has been advocated (2, 6).
Small primary RCC lesions appear effectively treated with nephron sparing surgery (partial nephrectomy), which produces apparently identical long-term disease-free survival compared with total nephrectomy, with long-term disease-free survival exceeding 90% in some series (1, 3, 4, 5). There appears to be a trend to nephron sparing RCC resective approaches over time (5), with one study advocating partial nephrectomy as the “standard of care,” in patients with small lesions (4).
Renal Cell Carcinoma
Written by Donald B. Fuller, M.D. – Radiation Oncologist