Urologic Clinics of North America

Contributors

2012-05-01

CME Accreditation Page and Author Disclosure

2012-05-01

Forthcoming Issues

2012-05-01

Foreword

Samir S. Taneja — 2012-05-01

Starting this year, I have agreed to take over as Consulting Editor for the Urologic Clinics. Many of you know that this position was previously held by Martin Resnick, someone who I considered to be a giant in our field since the time I was a student. As such, this is a great honor for me. The Urologic Clinics of North America has historically been a tremendous resource in American urology. During my training, this was the main source from which urologists gathered well-organized, condensed, up-to-date, information regarding focused topics in Urology.

Evolving Treatment Paradigms for Renal Cancer

William C. Huang, Samir S. Taneja — 2012-03-12

Over the past decade there have been steady advancements in the diagnosis, understanding, and management of renal cancers. While the mainstay of urologic therapy for both early- and late-stage disease remains surgery, new concepts in surgical management, novel therapeutic agents, and improved surgical technique have made treatment planning a more informed, multifactorial process. As such, despite the continued utilization of surgical therapy, the treatment paradigms utilized today have evolved considerably from those over the previous decade.

Histologic Variants of Renal Cell Carcinoma: Does Tumor Type Influence Outcome?

Fang-Ming Deng, Jonathan Melamed — 2012-03-09

Each histologic type of renal cell carcinoma (RCC) has different pathologic and clinical parameters; however, the independent role of histologic type in outcome prediction remains contested. Most studies show relevance for outcome of each histologic type when correlated with survival by univariate analysis, whereas few studies show differences in outcome once other key prognostic factors, such as stage and grade, are considered. These studies highlight the challenges to prove outcome relevance. Despite the contested independent value of type for outcome prediction, separation of RCC into types is well accepted and can be substantiated on clinical, pathologic, molecular, and general outcome differences.

The Surgical Approach to Multifocal Renal Cancers: Hereditary Syndromes, Ipsilateral Multifocality, and Bilateral Tumors

Brian Shuch, Eric A. Singer, Gennady Bratslavsky — 2012-02-24

Although the management of sporadic renal tumors is challenging enough, dealing with those with bilateral, multifocal, and hereditary kidney cancer adds an additional level of complexity. A clinician managing this patient population must understand the hereditary syndromes and the genetic testing available. Treating physicians must be familiar with enucleative surgery, complex or multiple tumor partial nephrectomy, complex renal reconstruction, re-operative renal surgery, and active surveillance strategies. With proper management, most patients affected with bilateral, multifocal, or hereditary RCC can have a long life expectancy while maintaining adequate renal function.

Current Practice Patterns in the Surgical Management of Renal Cancer in the United States

Ganesh Sivarajan, William C. Huang — 2012-03-05

Over the last two decades, there has been a rising incidence of renal tumors, particularly, small renal masses (<4 cm) resulting in a downward size and stage migration. This has brought about a paradigm shift in the management of newly diagnosed renal masses, such that nephron-sparing surgery, minimally invasive techniques, and active surveillance are frequently considered preferable to the historical gold standard of open radical nephrectomy. Population-based cohort studies indicate, however, that the widespread adoption of these techniques has been relatively slow and incomplete leading to significant disparities in the delivery of care throughout the country. Further investigation is required to determine the barriers to diffusion of new techniques and technology as well as to ensure equal access to quality care in the United States.

Contemporary Imaging of the Renal Mass

Stella K. Kang, Hersh Chandarana — 2012-03-01

Contemporary imaging techniques for renal mass evaluation are essential to clinical management and surgical planning. Ultrasonography can be used to distinguish cystic from solid lesions but is less sensitive and accurate in renal mass characterization than computed tomography (CT) and magnetic resonance imaging (MRI). Multiphase CT imaging before and after administration of contrast is the primary imaging modality for characterization and staging of renal lesions. MRI is increasingly used as a problem solving tool. Advanced MRI techniques such as diffusion-weighted imaging and perfusion-weighted imaging are being explored in assessment of renal lesions. These techniques are discussed in this article.

Approach to the Small Renal Mass: to Treat or Not to Treat

Simon P. Kim, R. Houston Thompson — 2012-02-22

Accurately conveying the benefits and risks of treatment interventions to patients diagnosed with small renal masses (SRMs) is essential to appropriately identify which patients will achieve better oncologic outcomes and confer a survival advantage from primary therapy. Treatment decisions to determine the ideal management with nephrectomy, thermal ablation, or active surveillance for patients diagnosed with an SRM remain highly complex. Existing prediction tools that incorporate various key clinical variables may facilitate an informed decision about the best management of SRM by more appropriately selecting treatment individualized to the characteristics of the SRM and the patient's clinical characteristics.

Does Renal Mass Ablation Provide Adequate Long-term Oncologic Control?

Stephen Faddegon, Jeffrey A. Cadeddu — 2012-02-17

Renal ablation (RA) is no longer used exclusively in patients with limited life expectancy. There are few studies reporting a minimum follow-up of 5 years. Biases and discrepancies within the literature are abundant. The outcomes of any series must be interpreted in the context of median follow-up time, reported tumor characteristics, ablation technique and training background of the practitioner, and the definition of tumor recurrence. The long-term oncologic efficacy of radiofrequency ablation (RFA) and cryoablation appear similar, although the percutaneous RFA technique may necessitate reablation in more cases. RA is associated with slightly higher rates of local recurrence compared to surgical excision.

The Influence of Surgical Approach to the Renal Mass on Renal Function

Brian R. Lane, Christopher M. Whelan — 2012-02-16

The National Kidney Foundation estimates that 26 million Americans are living with chronic kidney disease (CKD). The high prevalence of obesity, heart disease, hypertension, and diabetes places millions more at risk for developing CKD. Although long-term sufficient renal function is routine in screened kidney donors, CKD is present in more than 30% of patients with a newly diagnosed renal mass and develops in most patients who undergo radical nephrectomy and a portion of those who undergo nephron-sparing approaches. Herein, the authors review the effect of the surgical approach on renal function for patients presenting with a renal mass.

Partial Nephrectomy: Contemporary Outcomes, Candidate Selection, and Surgical Approach

Emil Kheterpal, Samir S. Taneja — 2012-05-01

Localized kidney cancer is ideally managed with surgical extirpation. Historically renal cell carcinoma has been treated with radical nephrectomy, but partial nephrectomy has become increasingly used because of a growing body of evidence demonstrating equivalent oncologic control and a potential benefit in overall survival. In this article, the authors demonstrate that partial nephrectomy carries excellent oncologic efficacy. They additionally review the growing indications for partial nephrectomy and factors influencing candidate selection. The authors also compare the relative outcomes of open and minimally invasive techniques. Several factors influence outcome, and surgeon experience should dictate the choice of technique.

Integration of Surgery and Systemic Therapy for Renal Cell Carcinoma

Patrick A. Kenney, Christopher G. Wood — 2012-05-01

Proper integration of surgery and systemic therapy is essential for improving outcomes in renal cell carcinoma (RCC). There is no current role for adjuvant therapy after nephrectomy for clinically localized disease. The potential benefits of neoadjuvant therapy for locally advanced nonmetastatic disease are in need of further study. In metastatic disease, the proper integration of cytoreductive surgery and systemic therapy remains to be elucidated. Presurgical targeted therapy is feasible and may be beneficial. Pending the results of randomized controlled trials, upfront cytoreductive nephrectomy in appropriate patients will likely continue as the paradigm of choice in metastatic RCC.

Defining an Individualized Treatment Strategy for Metastatic Renal Cancer

Brian Hu, Primo N. Lara, Christopher P. Evans — 2012-03-02

Treatment of metastatic renal cell carcinoma (mRCC) has evolved dramatically within the past 10 years with the advent of therapy targeting the angiogenesis and mammalian target of rapamycin (mTOR) pathways. These therapies rapidly supplanted immunotherapy as a first-line systemic treatment option. Response rates, however, continue to vary, largely due to mRCC's clinical and molecular heterogeneity. This article reviews current understanding of mRCC biology and available treatments, discusses novel biomarkers that improve prognostication and may be able to predict response, and integrates available literature on surgical and systemic therapies into an individualized strategy.

Index

2012-05-01

Urologic Clinics of North America

Contributors

Contents

CME Accreditation Page and Author Disclosure

Forthcoming Issues

Foreword

Evolving Treatment Paradigms for Renal Cancer

Histologic Variants of Renal Cell Carcinoma: Does Tumor Type Influence Outcome?

The Surgical Approach to Multifocal Renal Cancers: Hereditary Syndromes, Ipsilateral Multifocality, and Bilateral Tumors

Current Practice Patterns in the Surgical Management of Renal Cancer in the United States

Contemporary Imaging of the Renal Mass

Approach to the Small Renal Mass: to Treat or Not to Treat

Does Renal Mass Ablation Provide Adequate Long-term Oncologic Control?

The Influence of Surgical Approach to the Renal Mass on Renal Function

Partial Nephrectomy: Contemporary Outcomes, Candidate Selection, and Surgical Approach

Integration of Surgery and Systemic Therapy for Renal Cell Carcinoma

Defining an Individualized Treatment Strategy for Metastatic Renal Cancer

Index