A 70-year-old man with a 4 cm enhancing renal mass (cT1b) and solitary functioning kidney is being evaluated for treatment. Which nephron-sparing approach is preferred over radical nephrectomy?

• A Ablative therapy (cryoablation or radiofrequency ablation)
• B Active surveillance
• C Radical nephrectomy with immediate dialysis planning
• D Partial nephrectomy ✓

Explanation

Partial nephrectomy is the standard of care for cT1 renal masses when technically feasible, especially imperative in patients with a solitary kidney, bilateral tumours, CKD, or predisposing conditions (VHL disease). It achieves oncological equivalence to radical nephrectomy for T1 lesions while preserving renal function. Ablation is acceptable for patients unfit for surgery. Active surveillance is typically reserved for small (<3 cm), slow-growing incidental tumours in elderly/comorbid patients.

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.