{"id":5237,"date":"2019-04-12T18:35:32","date_gmt":"2019-04-12T22:35:32","guid":{"rendered":"https:\/\/www.med.unc.edu\/urology\/?p=5237"},"modified":"2020-04-08T16:05:04","modified_gmt":"2020-04-08T20:05:04","slug":"recent-jama-publication-by-bjurlin-suggests-small-kidney-tumors-can-be-managed-without-resection","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/urology\/recent-jama-publication-by-bjurlin-suggests-small-kidney-tumors-can-be-managed-without-resection\/","title":{"rendered":"Recent JAMA Publication by Bjurlin Suggests Small Kidney Tumors Can Be Managed Without Resection"},"content":{"rendered":"
\"Marc<\/a>
Marc Bjurlin, DO, MSc – One of the three authors for the recent JAMA publication “Management of Small Kidney Tumors in 2019”<\/figcaption><\/figure>\n

The approach to treating kidney tumors should always be personalized based on the patient\u2019s needs, but a recent publication<\/a> by UNC Urologist Marc Bjurlin, DO, MSc<\/a> and NYU Physicians Stella Kang, MD, MSc<\/a> and William C. Huang, MD<\/a> suggest expanding the recommendations set forth by the American Urological Association for treating small benign-appearing kidney tumors.<\/p>\n

Recognizing the low risk of developing metastatic disease from small lesions, the 2017 American Urological Association guidelines for treating kidney tumors recommend that patients with very small lesions (<2 cm) can undergo active surveillance rather than primary surgical treatment.<\/p>\n

This course of action can be difficult to communicate to patients as it requires an understanding of low-level, cancer-specific mortality risk for lesions of this size and in the absence of medical comorbidities, patients could be provided the option of pursuing a biopsy.<\/p>\n

Kidney tumors containing enhancing soft tissue on CT or MRI that do not have features typically observed in benign tumors should be considered malignant unless proven otherwise\u2014 as 75-80% of such lesions are ultimately confirmed to be malignant. In the past, because the malignant potential for small kidney tumors was unknown, they were usually resected. This is not an ideal approach as the other 20-25% of patients with benign lesions wouldn’t have required surgical intervention. Further, many of the patients with malignant lesions didn’t metastasize while under observation.<\/p>\n

Metastatic disease rates are currently only 1-2% in reported observational studies over 2 to 3 years and The Delayed Intervention and Surveillance for Small Renal Masses registry for all small kidney tumors <= to 4 cm support that these tumors are generally indolent; all patients who started with active surveillance had a 100% cancer-specific survival rate of over 5 years.<\/p>\n

In support, patients presenting with small kidney tumors are usually 60 years old or older when diagnosed and often have substantial comorbidities. Due to this, these patients have increased mortality after a kidney tumor resection, further favoring active surveillance.<\/p>\n