Surgical Treatment of 4–10 cm Renal-Cell Carcinoma: A Survey of the Lions and Gazelles

Abstract

Introduction:

The decision between partial nephrectomy (PN) and radical nephrectomy (RN) may be influenced by training, practice type, or location. We sought to evaluate current opinions about the optimal management of 4–10 cm renal-cell carcinoma (RCC).

Materials and Methods:

A survey was emailed to ∼2500 Endourologic Society and Society of Urologic Oncology members regarding training, practice setting, and interest in clinical trials in addition to questions about four patient scenarios. We evaluated the associations of demographic variables with specific answers.

Results:

399 physicians completed the survey with 37% and 34% completing urologic oncology and endourology fellowships, respectively. More respondents reported receiving adequate training in complex open PN compared with complex minimally invasive surgery (MIS) PN, 81% vs 37%. Eighty-three percent of respondents would offer a healthy patient a PN for a 7 cm exophytic mass. Receiving adequate training in complex PN is predictive of offering PN for a central RCC (p = 0.001). Academic practitioners were more likely to offer PN in these patients (p = 0.03). Those completing training after 2000 were more likely to offer MIS (p = 0.02), and respondents who completed an oncology fellowship were more likely to offer PN to unhealthy patients (p = 0.03).

Conclusions:

Opinions about the best treatment for 4–10 cm RCC differ significantly, with 70% of respondents willing to enroll patients in a randomized clinical trial. Effective efforts in teaching PN and minimally-invasive surgery result in practices that favor these approaches.