A 55-year-old male with a 6 cm upper pole renal cell carcinoma (clear cell) and no clinical nodal involvement is evaluated. His eGFR is 70 mL/min. What is the surgical approach of choice per AUA/EAU guidelines?
- A Radical nephrectomy (open or laparoscopic) as partial nephrectomy is inadequate for tumors > 4 cm
- B Partial nephrectomy (nephron-sparing) if technically feasible, regardless of size ✓
- C Thermal ablation (RFA or cryoablation) as first-line therapy
- D Active surveillance with repeat imaging in 6 months
Explanation
Current AUA and EAU guidelines recommend nephron-sparing surgery (partial nephrectomy) for T1a tumors (< 4 cm) as standard of care, and for T1b (4–7 cm) and even selected T2 tumors (> 7 cm) when technically feasible by experienced surgeons. A normal contralateral kidney with adequate function makes radical nephrectomy an option, but partial nephrectomy is preferred when achievable to preserve renal function and reduce long-term CKD risk. Oncological outcomes are equivalent for partial versus radical nephrectomy in T1-T2 disease when negative margins are achieved. Thermal ablation is reserved for high-surgical-risk patients.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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