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No. 182. Active surveillance for s mall r enal m asses : Outcomes within an Australian outpatient s etting. Dr Gideon A Blecher, Dr Sam S Farah, Prof Mark Frydenberg Department of Urology, Southern Health. Melbourne. Australia. Posters Proudly Supported by: . Introduction

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No. 182

Active surveillance for small renal masses: Outcomes within an Australian outpatient setting

Dr Gideon A Blecher, Dr Sam S Farah, Prof Mark Frydenberg

Department of Urology, Southern Health. Melbourne. Australia

Posters Proudly Supported by:

Introduction

Small renal masses (SRMs) are frequently encountered due to the increasing utilisation of abdominal imaging. The rate of metastases is low and a minority will be benign. Active surveillance (AS) has therefore emerged as a potential management option.

  • Results
  • 45 patients presented between August 2004 and March 2010 underwent AS for a SRM
  • Mean patient age: 67
  • 40 incidental, 5 haematuria
  • Average maximal diameter of 24mm
  • Intervention
  • 16 (36%) patients underwent further management
  • Mean age of patients undergoing intervention: 66
  • Intervention included nephrectomy (3), partial nephrectomy (9), and radiofrequency ablation (4). 
  • Reasons:
  • had diagnostic biopsy (3)
  • growth (2), (17mm over 6 month, 3mm over 3 month)
  • lesion became enhancing (2)
  • patient choice (1)
  • not clearly stated (8)
  • Biopsy
  • 7 biopsies (15.6% of patients), following mean 8 months of AS
  • 6 RCC, 1 non-diagnostic
  • Pathology Outcomes: all negative margins, T1
  • 6 Clear Cell RCC
  • 2 Papillary RCC
  • 2 Oncocytoma
  • 1 AML
  • 1 Leiomyoma
  • Growth Rates
  • SRM grew on average 3.5mm per year
  • Duration of Active Surveillance/NED
  • Mean 22 month duration (2-90) AS. 32 patients had >6month AS.
  • 7 patients have had post interventional follow up available. The mean duration of follow up subsequent to intervention is 18 months (5-37). No patients have developed metastatic disease or died from SRM.
  • Aim
  • To ascertain:
  • the growth rate of SRMs
  • the rate and reasons of cessation of surveillance
  • the rate of metastases and death from SRM
  • undergoing AS

Methods

A retrospective case series of all patients presenting with SRM to an outpatient Urological practice were reviewed.

Inclusion criteria: Patients with a SRM, initial size less than 4cm

Exclusion criteria: Lesions of initial size > 4cm, hyperdense cyst.

Conclusions

AS appears to be a safe method of managing patients with SRM. A minority of those undergoing AS will require further investigation (ie: biopsy) or definitive management as a result of growth or patient choice.

References

Rising incidence of renal cell cancer in the United States.Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. JAMA. 1999 May 5; 281(17):1628-31.

Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol. 2006 Feb;175(2):425-31.

Acknowledgements

Thank you to Mr M.Chong for providing some of the initial data