Delayed Management of Incidentally Detected Renal Masses Does Not Limit or Complicate Treatment Options

Rosalia Viterbo, Samir N. Chawla, Paul Crispen*, Richard E Greenberg, David Y.T. Chen, Robert G Uzzo
Fox Chase Cancer Center/ Temple University, Philadelphia, PA

Introduction:Prompt surgical management of RCC remains the standard of care. Occasionally, it may be necessary to postpone or delay surgical treatment. We evaluated the risks of delayed treatment for localized RCC and its implications on subsequent management.
Methods:We searched our institutional tumor registry to identify enhancing renal masses in which treatment was initially withheld, delayed or refused. Diagnostic imaging was obtained and reviewed at 3-6 month intervals or until surgical management was completed.
Results: We identified 138 solid enhancing renal masses in 116 patients over a 13yr period in whom management was postponed. Of these, 32 patients (median age 69 (range 42-87)) with 37 tumors underwent delayed definitive intervention. The median delay was 12mo (range 3-64) with 81% (30/37) delayed > 6 mo from presentation. The median tumor size at presentation was 2.2 cm (range 1.2-12.0). Definitive surgical intervention was pursued due to interval growth, improved PS, and/or patient choice. Treatments included percutaneous and laparoscopic ablation (cryo or RFA) (n=13), open or laparoscopic NSS (n=15), laparoscopic nephrectomy (n=4),and radical nephrectomy (n=5). Pathology confirmed RCC in 27 tumors, oncocytoma in 8 and complex cyst in 1. Treatment options were not compromised due to delay, such that 78% underwent nephron sparing approaches and 89% received a minimally invasive approach.
Conclusions: The natural history of small incidental renal masses is being defined. Management of these lesions may be cautiously delayed without limiting or complicating the treatment options available, including minimally invasive and nephron sparing approaches.

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