A 45-year-old man with a 3 cm solid right renal mass on CT (homogeneous enhancement, no fat) undergoes percutaneous biopsy showing clear cell renal cell carcinoma. He is fit for surgery. The most appropriate surgical approach is:

• A Radical nephrectomy (open or laparoscopic)
• B Percutaneous radiofrequency ablation
• C Active surveillance for 1 year then reassess
• D Nephron-sparing partial nephrectomy (robotic or laparoscopic) ✓

Explanation

For renal masses ≤4 cm (T1a) in fit patients, nephron-sparing partial nephrectomy is the gold standard surgical treatment, preserving renal function while achieving oncological equivalence to radical nephrectomy. EAU guidelines recommend partial nephrectomy whenever technically feasible for T1 tumors. Radical nephrectomy is reserved for technically unresectable anatomy or T2+ disease. Ablative therapies (RFA, cryotherapy) are alternatives for small tumors in patients unfit for surgery. Active surveillance is reserved for elderly, comorbid, or small (<1.5 cm) tumors.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.