Oncology Therapeutics and Drug Development
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ABSTRACT
The increasing use of cross-sectional imaging has resulted in a rising incidence of incidentally detected small renal masses (SRMs), defined as enhancing renal tumors ≤4 cm. Management has evolved from routine surgery to individualized, risk-based strategies.
Methods: A structured narrative review was performed following PRISMA-aligned principles. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched for studies published between January 2000 and December 2025. Eligible studies included adult patients with SRMs managed by active surveillance (AS), partial nephrectomy (PN), or percutaneous thermal ablation. Thirty studies met inclusion criteria and were synthesized qualitatively.
Results: SRMs generally demonstrate slow growth kinetics, with mean growth rates of approximately 0.25–0.3 cm/year, and the risk of metastatic progression during AS remains low (<3%) in appropriately selected patients. PN provides excellent long- term oncologic control and superior renal function preservation and remains the preferred treatment for surgically fit patients. Thermal ablation offers a minimally invasive alternative with favorable functional outcomes and acceptable oncologic control, although local recurrence rates are slightly higher than with PN.
Conclusions: Management of SRMs should be individualized according to patient comorbidity, tumor characteristics, and life expectancy. AS, thermal ablation, and PN each represent valid treatment strategies, and shared decision-making is essential to optimize outcomes.
Keywords: Small Renal Mass; Active Surveillance; Partial Nephrectomy; Thermal Ablation; Renal Cell Carcinoma