Objective: To identify clinical parameters influencing German urologists treating cT1a renal tumours, we performed a nationwide survey among members of the German urological associations (DGU and BDU). Material and Methods: In spring 2012, DGU and BDU members were invited to complete our survey. For 8 cases and 3 index patients, participants were asked about their preferred treatment. Multivariate analyses were used to identify significant parameters leading the responders to favour radical nephrectomy (RN) over nephron sparing surgery (NSS) as well as active surveillance (AS) over invasive treatment. Results: Three hundred six (7.4%) forms were included in our analysis. In patients with larger tumours (4 vs. 2 cm, OR 3.16), endophytic growth (endophytic vs. exophytic, OR 2.70), hilar tumour location (perihilar vs. polar, OR 14.37), normal renal function (normal vs. decreased, OR 1.92) and elderly patients (elderly vs. young, OR 2.14) RN was preferred. Based on decreased renal function (decreased vs. normal, OR 12.74), elderly (elderly vs. young, OR 14.31) and hilar tumour location (perihilar vs. polar, OR 2.14), 77.2% of respondents recommended AS for selected patients. Treating physician factors had no influence on the treatment preference. Conclusions: Elderly patients with small tumours and impaired renal function were candidates for AS. Younger patients mainly underwent NSS. However, when the tumours' location was endophytic or hilar, RN was recommended.

Keywords:
Small renal mass, Active surveillance, Nephron-sparing surgery, Radical nephrectomy, Elderly, Thermoablation, Renal function, Tumour location
1.
Sacco E, Pinto F, Totaro A, et al: Imaging of renal cell carcinoma: state of the art and recent advances. Urol Int 2011;86:125-139.
2.
Ljungberg B, Cowan NC, Hanbury DC, et al: EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010;58:398-406.
3.
Van Poppel H, Da Pozzo L, Albrecht W, et al: A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011;59:543-552.
4.
Miyamoto K, Inoue S, Kajiwara M, Teishima J, Matsubara A: Comparison of renal function after partial nephrectomy and radical nephrectomy for renal cell carcinoma. Urol Int 2012;89:227-232.
5.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-1305.
6.
Huang WC, Elkin EB, Levey AS, Jang TL, Russo P: Partial nephrectomy versus radical nephrectomy in patients with small renal tumors - is there a difference in mortality and cardiovascular outcomes? J Urol 2009;181:55-61; discussion 61-62.
7.
Thompson RH, Boorjian SA, Lohse CM, et al: Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 2008;179:468-471; discussion 472-473.
8.
Patel SG, Penson DF, Pabla B, et al: National trends in the use of partial nephrectomy: a rising tide that has not lifted all boats. J Urol 2012;187:816-821.
9.
Zini L, Patard JJ, Capitanio U, et al: The use of partial nephrectomy in European tertiary care centers. Eur J Surg Oncol 2009;35:636-642.
10.
Pahernik S, Ziegler S, Roos F, Melchior SW, Thüroff JW: Small renal tumors: correlation of clinical and pathological features with tumor size. J Urol 2007;178:414-417; discussion 416-417.
11.
Remzi M, Ozsoy M, Klingler HC, et al: Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol 2006;176:896-899.
12.
Snyder ME, Bach A, Kattan MW, Raj GV, Reuter VE, Russo P: Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. J Urol 2006;176(6 pt 1):2391-2395; discussion 2395-2396.
13.
Breau RH, Crispen PL, Jenkins SM, Blute ML, Leibovich BC: Treatment of patients with small renal masses: a survey of the American Urological Association. J Urol 2011;185:407-413.
14.
Wafaisade A, Wyen H, Mutschler M, et al: [Current practice in coagulation and transfusion therapy in multiple trauma patients: a German nation-wide online survey]. Unfallchirurg 2015;118:1033-1040.
15.
Steffens S, Junker K, Roos FC, et al: Small renal cell carcinomas - how dangerous are they really? Results of a large multicenter study. Eur J Cancer 2014;50:739-745.
16.
Huang WC, Levey AS, Serio AM, et al: Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 2006;7:735-740.
17.
Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H: Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol 2014;65:372-377.
18.
Baillargeon-Gagné S, Jeldres C, Lughezzani G, et al: A comparative population-based analysis of the rate of partial vs radical nephrectomy for clinically localized renal cell carcinoma. BJU Int 2010;105:359-364.
19.
Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Wei JT: National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology 2006;67:254-259.
20.
Miller DC, Hollingsworth JM, Hafez KS, Daignault S, Hollenbeck BK: Partial nephrectomy for small renal masses: an emerging quality of care concern? J Urol 2006;175(3 pt 1):853-857; discussion 858.
21.
Nuttall M, Cathcart P, van der Meulen J, Gillatt D, McIntosh G, Emberton M: A description of radical nephrectomy practice and outcomes in England: 1995-2002. BJU Int 2005;96:58-61.
22.
Hellenthal NJ, Mansour AM, Hayn MH, Schwaab T: Renal cell carcinoma in octogenarians: nephron sparing surgery should remain the standard of care. J Urol 2011;185:415-420.
23.
Kates M, Badalato G, Pitman M, McKiernan J: Persistent overuse of radical nephrectomy in the elderly. Urology 2011;78:555-559.
24.
Lowrance WT, Yee DS, Savage C, et al: Complications after radical and partial nephrectomy as a function of age. J Urol 2010;183:1725-1730.
25.
Roos FC, Brenner W, Jäger W, et al: Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron-sparing surgery or radical nephrectomy for renal tumours larger than 4 cm. BJU Int 2011;107:554-561.
26.
Volpe A, Cadeddu JA, Cestari A, et al: Contemporary management of small renal masses. Eur Urol 2011;60:501-515.
27.
Kutikov A, Kunkle DA, Uzzo RG: Focal therapy for kidney cancer: a systematic review. Curr Opin Urol 2009;19:148-153.
28.
Van Poppel H, Becker F, Cadeddu JA, et al: Treatment of localised renal cell carcinoma. Eur Urol 2011;60:662-672.
29.
Tomaszewski JJ, Uzzo RG, Smaldone MC: Heterogeneity and renal mass biopsy: a review of its role and reliability. Cancer Biol Med 2014;11:162-172.
30.
Lane BR, Poggio ED, Herts BR, Novick AC, Campbell SC: Renal function assessment in the era of chronic kidney disease: renewed emphasis on renal function centered patient care. J Urol 2009;182:435-443; discussion 443-444.
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2016
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