Objectives: To analyze the impact of preoperative clinical data that could influence the undertaking of small renal masses (size<4cm) and to direct patients towards surgery or observance or radiofrequency.
Patients and methods: From January 2000 to December 2010, 253 small renal masses were included in a retrospective study. Renal masses less than 3cm were compared to the 3 to 4cm masses. Clinical data, pathological data and follow-up was noted prospectively on the database and we analyzed it according to the treatment done (surgery, radiofrequency or observation).
Results: Surgical treatment, radiofrequency and observation were performed for 214 (86.4%), 15 (5.9%), and 24 (9.5%) patients respectively. The treatments of the patients differed in the two groups (<3cm vs. 3-4cm) and the appeal to radiofrequency and observation was more frequent for elder patients (>65years old) and for those whom performance status (ECOG status) greater or equal to 1. Cancer specific survival was not statistically different for the two groups (average: 87.5% after 5years, mean 33months follow-up, P=0.7). Independent risk factors of recurrence were Fuhrman grade, synchronous tumors, noddles invasion and metastatic progression. Positive surgical margins were not a risk factor of recurrence (P=0.6).
Conclusion: Age and performance status are the two main clinical data, which influence the treatment for patients with small renal masses. Radiofrequency and observation were undertaken more regularly for elder and altered ones. The use of scales as Charlson Index or Lee scale could help to choose more easily according to global morbidity and mortality.
Copyright © 2012 Elsevier Masson SAS. All rights reserved.