1358 LONG-TERM FOLLOW-UP OF PATIENTS INITIALLY MANGED WITH ACTIVE SURVEILANCE FOR SOLID RENAL MASSES

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

In recent years some institutions, include our own, have reported on the relatively short-term follow-up of expectant management of small renal masses. This study sought to provide a long-term follow-up of our initial series of patients whose renal masses were managed expectantly (i.e. “watchful waiting”) to provide some insight into the feasibility and safety of this approach in the long term.

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METHODS 

43 patients with 46 renal masses underwent planned expectant management strategy of solid, enhancing renal masses initiated between 12/99 – 1/05. Follow-up of this initial cohort with regard to age, gender, rate of growth, subsequent interventions, and follow-up are reported.

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RESULTS 

Mean (median) follow-up of the entire cohort is 57.4 (64.9) months. The mean (median) initial tumor size was 2.9 cm (2.9 cm) and the mean (median) growth rate of the tumors was 0.6 cm/yr (0.2 cm/yr) with 12 (26%) of tumors having no growth. For the entire group, 6 patients were lost to follow-up (or refused follow-up) before intervention at a mean time 24.8 months. For the remaining 37 patients (40 tumors) the mean (median) follow up was 62.5 (65.5) months. Of these, 17 tumors in 15 patients have remained on surveillance and 23 tumors in 22 patients have undergone an intervention. Of the 15 patients (17 tumors) on surveillance, 8 patients (comprising 10 tumors) have died in their follow-up at a mean time from diagnosis of 45.7 months – all of other causes. No patient on surveillance has developed a metastasis or death secondary to renal carcinoma. 23 tumors (22 patients) have undergone an intervention with an overall mean (median) follow-up from diagnosis of 65.0 (68.0) months and with a mean (median) time from diagnosis to intervention of 25.1 (21.9) months. These patients have undergone surgery (19), cryotherapy (2), and RFA (2), with 2 patients requiring second intervention (repeat partial nephrectomy, repeat RFA). No patient in the intervention subgroup has developed a known metastasis nor has died of renal carcinoma at a mean follow-up of 65.0 (68.0) months with 2 patients dying of other causes. (5 patients in the intervention group were eventually lost to follow-up at a mean time of 23.9 months after treatment.)

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CONCLUSIONS 

Active surveillance for renal masses remains an appropriate option for the carefully selected patients – especially those with competing co-morbidities. The long-term follow-up of such patients demonstrates the safety of this approach, and delayed intervention does not appear to adversely impact clinical outcomes.