A 65-year-old man presents with haematuria and a 5 cm renal mass on CT with radiological features of clear cell renal cell carcinoma. There is no evidence of venous involvement or distant metastasis. He has a solitary functioning kidney. The preferred nephron-sparing approach is:
- A Partial nephrectomy (open or laparoscopic/robotic) to preserve renal function while achieving adequate oncological margins ✓
- B Radical nephrectomy followed by chronic haemodialysis
- C Percutaneous radiofrequency ablation regardless of tumour size
- D Sunitinib targeted therapy as primary treatment for the renal mass
Explanation
Partial nephrectomy is strongly indicated when the patient has a solitary kidney, bilateral tumours, or chronic kidney disease, as radical nephrectomy would render the patient dialysis-dependent. Guidelines (EAU, AUA) recommend nephron-sparing surgery (partial nephrectomy) as the gold standard for T1a tumours (<4 cm) and as the preferred option in imperative cases (solitary kidney) regardless of tumour size. RFA/ablation is reserved for patients unfit for surgery or T1a (<4 cm) lesions when surgery is contraindicated. Sunitinib is first-line for metastatic RCC, not localised disease.
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.