Renal Cortical Neoplasms and Associated Renal Functional Outcomes

In 2010 alone there were an estimated 54,000 new diagnoses and 12,000 deaths attributable to renal cell carcinoma (RCC), with the vast majority of these tumors consituting small renal masses incidentially detected on cross-sectional imaging.(2010; Chow, Dong, and Devesa, 2010) Renal cortical tumors include a complex family of neoplasms with unique histology, cytogenetic effects, and metastatic potential; the differential presentation of symptomatic, locally advanced disease as opposed to small renal tumors (median tumor size <4cm, T1a) evokes different management paradigms.(Lee et al., 2010; McKiernan et al., 2002b; Mitchell et al., 2006; Russo et al., 2002) This large subcategory of patients with localized RCC have historically been treated with radical nephrectomy, and this management has continued in many regions of the United Stes and the world.(Hollenbeck et al., 2006) Nevertheless, a paradigm shift has occured in the surgical management of renal cortical tumors over the last 10 years, favoring nephron-sparing surgery or partial nephrecotmy whenever this approach is feasible from a technical and oncologic standpoint. The rationale underpinning this shift has involved the observed non-inferiority in terms of cancer control and operative morbidity as well as the superior renal functional outcomes. Within the neprhology and urology communities, the last decade has also witnessed a increased understanding of how renal volume effects renal function, and how this in turn affects cardiovascular competence. It now is evident that having less renal parenchyma does not only worsen renal function, but it also is a poor prognosticator of cardiac function and overall survival. It is within this context that a review of renal functional outcomes following surgery for renal coritcal tumors can be undertaken.