OnCo
ideasIdea

Watch small kidney tumours rather than remove them, with a national registry

Most kidney tumours under 3 cm found by chance grow slowly and a fifth are benign. Watching them, with surgery only if they grow, could spare many operations.

The DISSRM registry and Canadian cohorts show growth under 0.3 cm per year and rare metastasis for small renal masses under surveillance. Propose surveillance with renal mass biopsy for grade as the default for masses under 3 cm in patients over 65, with a national registry and explicit intervention triggers.

Hypothesis
Default surveillance cuts nephrectomy and ablation for small renal masses by at least half with a metastasis rate under 2% at five years.
Rationale
Existing cohorts support safety, and nephron preservation improves cardiovascular outcomes.
What would test it
Registry with pre-specified safety monitoring plus a randomised decision-support trial.
Maturity
early clinical
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
4
Bottlenecks it attacks

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