Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
Eur Urol. 2011 Sep;60(3):501-15. doi: 10.1016/j.eururo.2011.05.044. Epub 2011 Jun 1.
An increasing number of small renal masses (SRMs) with heterogeneous histology and clinical behaviour are being detected with modern radiologic imaging. Although surgical removal is the standard of care for small renal tumours, alternative minimally invasive and conservative treatment options are possible in selected patients with shorter life expectancy.
To systematically review indications, techniques, and outcomes of surgical and conservative treatments of SRMs.
A literature search of English-language publications was performed using the Medline database from January 2000 to February 2011 using the terms renal mass and renal carcinoma in conjunction with the evaluated management options. The articles that provided the highest level of evidence were selected with the consensus of all the authors and reviewed.
Only one randomised controlled trial comparing the results of elective nephron-sparing surgery and radical nephrectomy for low-stage renal tumours is available. Few comparative studies of different treatment options for SRMs have been published. The assessment of oncologic outcomes is therefore based mainly on observational studies. Most series of nonsurgical therapies have strong selection biases and relatively short follow-up. Treatment selection is based on the clinical and histologic characteristics of SRMs, on patient age and comorbidities, and on personal preferences and experience of the urologist.
Partial nephrectomy (PN) is the standard treatment for solitary SRMs whenever it is technically feasible. Laparoscopic PN is an alternative to open PN in experienced hands. The rationale of ablative treatments is to treat incidental cortical SRMs in patients at high surgical risk with potentially reduced morbidity. Active surveillance is considered an appropriate strategy for the elderly or for patients with significant comorbidity who have a shorter life expectancy. Percutaneous biopsies are increasingly being used to establish histology of SRMs and support treatment decisions, especially for patients who are candidates for nonsurgical treatment.
随着现代影像学的发展，越来越多具有异质性组织学和临床行为的小肾肿瘤（SRM）被发现。虽然手术切除是小肾肿瘤的标准治疗方法，但对于预期寿命较短的选择患者，可能存在替代的微创和保守治疗方法。
系统评价 SRM 的手术和保守治疗的适应证、技术和结果。
使用 Medline 数据库从 2000 年 1 月至 2011 年 2 月，以“肾肿瘤”和“肾细胞癌”为关键词，结合评估的治疗选择，进行了英语文献的检索。选择提供最高证据水平的文章，并由所有作者达成共识进行审查。
只有一项比较选择性肾部分切除术和根治性肾切除术治疗低分期肾肿瘤结果的随机对照试验。发表的比较不同 SRM 治疗选择的比较研究较少。因此，肿瘤学结果的评估主要基于观察性研究。大多数非手术治疗系列都存在强烈的选择偏倚和相对较短的随访。治疗选择基于 SRM 的临床和组织学特征、患者年龄和合并症，以及泌尿科医生的个人偏好和经验。
只要技术上可行，部分肾切除术（PN）是治疗单发 SRM 的标准治疗方法。在有经验的手中，腹腔镜 PN 是开放 PN 的替代方法。消融治疗的原理是用潜在减少发病率的方法治疗具有高手术风险的偶然皮质 SRM。主动监测被认为是一种适合老年患者或预期寿命较短、合并症严重的患者的策略。经皮活检越来越多地用于建立 SRM 的组织学并支持治疗决策，特别是对于那些适合非手术治疗的患者。
