Active surveillance of small kidney masses decent substitute for surgery, study finds

Rather than immediate surgery, a new study published in the November edition of the urology journal BJUI finds that active surveillance of minimal kidney masses can be a suitable, equally-effective alternative as far as cancer survival rates are concerned.

Researchers from the Department of Urology at the Churchill Hospital, Oxford, UK, found that — especially when treating elderly patients with complex health issues, who tend decline surgery — the new watchful method has a similar effect on overall cancer specific survival rates as going under the knife does.

"Our research suggests that active surveillance of small kidney masses offers similar cancer outcomes to radical or partial surgery in the short and intermediate term" said lead study author Nilay Patel, MD, in a news release.

"The incidence of kidney cancer has been increasing in Europe and the USA since the 1980s and the use of more sophisticated imaging techniques means that smaller masses of less than 4cm are being picked up at earlier stages" Patel continued. "This has led to an increased rate of surgery for small kidney masses, but the benefits of this remain unclear. Conflicting reports on improvements in death rates for kidney cancer over the last few years suggest that increased detection may not necessarily be improving survival rates for patients with smaller tumours inside their kidney."

Patel and his team involved a total of 202 patients with 234 small renal masses of less than 4cms inside their kidneys (T1a) in the study. Ninety patients had their masses treated with partial nephrectomies; 41 patients tended to their masses via radical nephrectomies; and 71 patients were actively surveyed, meaning they were extensively monitored for any signs of disease progression.

The results were as follows:

  • Over a median follow-up of 34 months, the mean growth rate of the kidney masses in patients who were under active surveillance was 0.21cm. However, 53 per cent of the small renal masses in these patients showed negative or zero growth.
  • No statistically significant differences were observed in overall and cancer-specific survival rates for patients who were under active surveillance or received partial or radical nephrectomy.
  • The overall survival rates were 83 per cent for active surveillance, 80 per cent for radical nephrectomy and 90 per cent for partial nephrectomy.
  • The cancer specific survival rates were 99 per cent for active surveillance, 93 per cent for radical nephrectomy and 97 per cent for partial nephrectomy.

"The results of this study support the need for a multicentre, prospective randomised trial to compare how active surveillance and surgery compare when it comes to managing such patients,” Patel concluded.

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