Management of c/pT3a Renal Cell Carcinoma in Light of EAU Guidelines
Introduction: The diagnosis and management of cT3a renal cell carcinoma with perirenal fat invasion (cT3a-PFI) remain complex due to the lack of standardized imaging protocols and the ambiguity in surgical decision-making. The aim of this review is to analyze this management approach primarily throu...
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| Format: | Article |
| Language: | English |
| Published: |
university of basrah
2025-06-01
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| Series: | Basrah Journal of Surgery |
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| Online Access: | https://bjsrg.uobasrah.edu.iq/article_187496.html |
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| Summary: | Introduction: The diagnosis and management of cT3a renal cell carcinoma with perirenal fat invasion (cT3a-PFI) remain complex due to the lack of standardized imaging protocols and the ambiguity in surgical decision-making. The aim of this review is to analyze this management approach primarily through European and French guidelines.
Methods: A literature search was conducted using PubMed, with keywords including "Renal cell carcinoma," "cT3a," "pT3a," and "perirenal fat invasion." Studies published in English between 2000 and 2024 were included. After screening, 42 articles were selected based on relevance, study design, and level of evidence.
Results: Studies report better recurrence-free survival (RFS) and cancer-specific survival (CSS) for cT3a-PFI compared to sinus or vascular invasion. However, preoperative diagnosis remains challenging, with imaging features such as tumor contour irregularity showing low specificity for tumors >4 cm. Partial nephrectomy (PN) offers comparable oncological outcomes to radical nephrectomy (RN) for tumors ≤7 cm, while RN is preferred for larger tumors due to technical complexity and risk of positive margins. The favorable prognosis of cT3a-PFI ≤4 cm suggests these tumors may warrant reclassification within the TNM staging system.
Discussion: The retrospective nature of most studies introduces selection bias, limiting the robustness of findings. Despite advancements, the lack of standardized diagnostic criteria remains a major barrier. Future research should refine surgical guidelines and explore advanced techniques such as radiomics and artificial intelligence.
Conclusion: An individualized surgical approach tailored to tumor size and technical feasibility remains key to optimizing outcomes in cT3a-PFI RCC. Prospective studies are needed to address limitations and improve management. |
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| ISSN: | 1683-3589 2409-501X |