Question

Treatment of renal cell carcinoma of less than 4 cm will be:

• A. Partial nephrectomy
• B. Radical nephrectomy
• C. Radical nephrectomy + postoperative radiotherapy
• D. Radical nephrectomy + chemotherapy

Hint:

Small tumour, spare the nephrons.

Answer 1

The Correct Option is A

Stage the tumour: Less than 4 cm and confined to the kidney is stage T1a. That single fact decides the operation.

Nephron-sparing principle: Modern urology preserves renal tissue whenever it can, because saving nephrons protects long-term kidney function without losing cancer control for small tumours. So a T1a RCC is removed by partial nephrectomy, not by taking the whole kidney.

Knock out the wrong options: Two facts kill three options at once. First, radical nephrectomy is overtreatment for a 4 cm lesion, so option B is out. Second, RCC is notoriously resistant to both radiotherapy and conventional chemotherapy, so bolting either onto surgery in localised disease, options C and D, adds toxicity with no gain.

Pearl: Partial nephrectomy is mandatory in a solitary kidney, bilateral tumours or poor reserve, and is now the preferred elective choice for any small RCC, deliverable by open, laparoscopic or robotic routes.

Ref: Bailey and Love, Short Practice of Surgery, 27e, Pg 1420.