Incidentally discovered renal masses: oncological and perioperative outcomes in patients with delayed surgical intervention

Abstract

Objective: To evaluate whether a period of surveillance before laparoscopic partial nephrectomy (LPN) affects the pathological and clinical outcomes of patients with a small renal mass, as although the standard treatment for an enhancing renal mass remains surgical extirpation, surveillance of small renal masses has become a potential option in appropriately selected patients.

Patients and methods: The clinical and pathological data of 32 patients who had LPN for a small clinical stage T1a renal mass after a surveillance period of >or=3 months was analysed and compared with those from a matched group of patients who had immediate LPN.

Results: The mean interval between diagnosis and LPN in the surveillance group was 15.8 months. The mean tumour size at presentation was 1.97 cm in the surveillance group with a growth rate of 0.56 cm/year. The proportion of patients upstaged from cT1 to pT3a was no different between the groups. There was no difference between the groups in warm ischaemia time, blood loss, operating room time, complications and length of stay after LPN. At the last follow-up (mean 60 months) there were no local recurrences or distant metastases.

Conclusion: Baseline size does not appear to predict tumour malignant potential, and growth rates of malignant and benign tumours were similar in the two groups. A delay in surgery of >1 year was not associated with added surgical morbidity, nor did it preclude patients from undergoing definitive surgery via a minimally invasive approach with an equally effective early oncological outcome.