Editing Renal Mass and Localized Renal Cancer (2021) (section)

===== Nephrectomy =====
* '''<span style="color:#ff0000">Risk-stratified into (4):'''
*# '''<span style="color:#ff0000">Low-risk: pT1 and Grade 1/2'''
*# '''<span style="color:#ff0000">Intermediate-risk: pT1 and Grade 3/4, or pT2 any Grade'''
*# '''<span style="color:#ff0000">High-risk: pT3 any Grade'''
*# '''<span style="color:#ff0000">Very high-risk: pT4 or pN1, or sarcomatoid/rhabdoid dedifferentiation, or macroscopic positive margin'''
** '''If final microscopic surgical margins are positive for cancer, the risk category should be considered at least one level higher''', and increased clinical vigilance should be exercised.
* '''<span style="color:#ff0000">Follow-up based on risk stratification'''
** '''<span style="color:#ff0000">See [https://www.auanet.org/documents/Guidelines/PDF/RCC-Follow-Up-Algorithm.pdf Table 1] from original guidelines'''
***'''<span style="color:#ff0000">If low-risk, abdominal and chest imaging at 12, 24, 48 and 60 months'''
***'''<span style="color:#ff0000">If intermediate-risk, abdominal and chest imaging at 6, 12, 24, 36, 48 and 60 months'''
* '''Imaging:'''
** '''Abdominal'''
*** '''After 2 years, abdominal ultrasound (US) alternating with cross-sectional imaging may be considered in the low- and intermediate-risk groups at physician discretion.'''
*** '''After 5 years, informed/shared decision-making should dictate further abdominal imaging.'''
** '''Chest'''
*** '''Modality'''
**** '''Chest x-ray low- and intermediate-risk groups'''
**** '''CT chest for high and very high-risk groups.'''
*** '''After 5 years, informed/shared decision-making discussion should dictate further chest imaging and chest x-ray may be utilized instead of chest CT for high and very high-risk groups.'''