ABSTRACT

Small renal masses are defined as solid renal tumors that are generally low stage and relatively small (< 4 cm in diameter) at presentation and are suspected of being renal cell carcinomas. The tumor is benign in 20% of these patients. The incidence of small renal masses continues to rise, largely due to the widespread use of modern imaging techniques, clinic researches , improved diagnostic and therapeutic tools. Although surgical management, predominantly by nephron-sparing, remains the standard of care to due its durable oncological and favorable functional outcomes, active surveillance has emerged as an alternative to surgery particularly in elderly patients with multiple comorbidities. To date, there is not a standardized follow-up protocol for surveillence. Patient, tumor and surgeon characteristics all influence the choice of active surveillance. Active surveillance can be offered to the patients with a tumor size <3 cm and poor performance status. Active surveillence is not suitable for young, healthy and long life expectancy. In this review, we discussed different treatment alternatives in small renal masses and the feasibility of active surveillence in this group of patients.