0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1
1288 Renal Masses and Tumors■Surgery+Adjuvant/Neoadjuvant Therapy (Biologic Response Modi-
fiers; i.e. cytokine-based therapy) for advanced disease
specific therapy
Treatment Options
■Partial Nephrectomy
➣Indications (relative)
Tu m o r < 4 c m
Bilateral renal neoplasms
Hypertension
Urolithiasis
Renal insufficiency
Solitary kidney
■Radical Nephrectomy
➣Open vs. Laparoscopic
Approach depends on:
Experience/expertise of surgeon
Anatomical considerations
Tumor size, location, extent
Prior abdominal/retroperitoneal surgeryfollow-up
■Post-surgical follow-up at 2–4 weeks postop
■CT Abdomen and Pelvis, CXR, and Alkaline Phosphatase as clinically
indicated, based on stage/grade of disease
complications and prognosis
Stage/Treatment: 5-Year Survival
■Nephron-sparing surgery:∼87%
■Radical Nephrectomy, Stage I:∼75%
■Radical Nephrectomy, Stage II:∼66%
■Radical Nephrectomy, Stage III (venous extension):∼55%
■Metastatic to Regional Nodes:∼25%
■Distant Metastases:∼4.5%
■Radical Nephrectomy w/ simultaneous excision of a solitary meta-
stasis:∼22%
■Excision of solitary metastasis following radical nephrectomy:∼40%
Cell Type
■Clear Cell Alone:∼64%
■Any Granular Cell:∼53%
■Spindle, Sarcomatoid, Anaplastic:∼24%