ABSTRACT
Over 36 000 new cases of renal cell carcinoma (RCC) are diagnosed annually and more than 12 000 deaths occur from this disease each year in the United States.1 Radical nephrectomy has been the gold standard for the management of renal tumors since Robson and colleagues reported greater survival in patients who underwent this procedure compared those who underwent simple nephrectomy.2 However, widespread use of abdominal computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI) has led to an increased detection of incidental and relatively small renal masses. Approaches to managing small renal masses have evolved in the last two decades. Indications for nephron-sparing surgery have expanded, and minimally invasive procedures, which can confer advantages over open surgery, are now available. Ablative techniques offer a combination of nephron-sparing and minimally invasive approaches. Watchful waiting in selected cases is occasionally offered as an option, based on data suggesting that small lesions (3cm) are slow-growing and may not pose a risk for progression and dissemination.3-6 Ablative techniques include cryoablation, radiofrequency ablation (RFA), and high-intensity focused ultrasound. Ablative techniques require long-term studies to confirm lasting efficacy. The best modality for tumor targeting, monitoring of therapy, and follow-up remains under investigation.
