A 55-year-old man with a 4.2 cm solid enhancing renal mass (cT1bN0M0) is evaluated for surgery. He has a solitary contralateral kidney with borderline function (eGFR 55). The preferred surgical approach according to EAU guidelines is:

• A Radical nephrectomy — size >4 cm mandates radical approach
• B Thermal ablation — preferred for all T1 lesions to preserve function
• C Active surveillance — only biopsy if surveillance imaging shows growth
• D Partial nephrectomy — nephron-sparing surgery is preferred even for T1b tumors ✓

Explanation

EAU guidelines recommend partial nephrectomy (nephron-sparing surgery) as the preferred approach for T1 renal tumors (≤7 cm) whenever technically feasible, particularly when the patient has risk factors for CKD progression — including solitary kidney, bilateral tumors, compromised contralateral kidney function, or hereditary RCC syndromes. For a patient with a contralateral solitary kidney and already reduced eGFR (55 mL/min), preservation of nephrons is paramount. Radical nephrectomy risks rendering the patient dialysis-dependent. Thermal ablation has higher local recurrence rates and is reserved for high-surgical-risk patients. Surveillance is for small indeterminate or confirmed low-grade small renal masses in elderly/frail patients.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.