Close Monitoring of Renal Tumors May Provide Alternative to Surgery
In patients with small renal tumors confined to the kidneys, close, active monitoring, as opposed to immediate surgery, is associated with low rates of tumor growth or death, according to a study by researchers at the Icahn School of Medicine at Mount Sinai and Fox Chase Cancer Center, part of the Temple University Health System, published in the September issue of the Journal of Urology.
Although surgical excision of tumors remains the standard of care for renal tumors that have not yet spread (localized), the risk of complications in elderly or ill patients may outweigh the benefits of surgery. The study suggests that actively monitoring renal tumors in some patients may prove a safer option than immediate surgery.
The incidence of kidney cancer in the United States has been increasing for two decades, with the trend partly attributed to the introduction of abdominal imaging studies such as CT scans or MRIs in the 1980’s. However, death rates due to renal cell carcinoma (kidney cancer) have not decreased, indicating that surgery may be of little or no benefit to some patients.
“We are beginning to better understand the behavior of tumors that grow on the kidneys,” said Reza Mehrazin, MD, Assistant Professor, Urology, Icahn School of Medicine at Mount Sinai, the study’s lead investigator. “In some patients, particularly those who are considered elderly or ‘high risk,’ we are now more likely able to delay surgery, sometimes indefinitely.” Much of the work behind the study was completed while Dr. Mehrazin was a researcher at Fox Chase Cancer Center.
In cases which are likely to result in surgery, it is important that urologists understand the natural history of renal tumors. If surgery does prove necessary, minimally invasive surgery using robotic tools may be possible. For example, a robotic partial nephrectomy provides the surgeon with enhanced visualization and precision during the procedure, which translates to significantly less blood loss. Moreover, the incisions are smaller and result in less pain and shorter recovery time and hospital stay.
“Patients diagnosed with renal tumors have more options than ever before, said Dr. Mehrazin. “Surgery is not always the best solution. It is vital that patients consult with their urologists to explore all options and make the best treatment decision for that particular case.”
About Fox Chase Cancer Center
Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet status for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, visit Fox Chase’s Web site at www.foxchase.org or call 1-888-FOX CHASE or (1-888-369-2427).
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals."