Close observation is the standard of care for patients following surgical resection for nonmetastatic renal cell carcinoma. The primary treatment of suspected renal cell carcinoma is surgery. Staging is predicated on tumor size as well as extension into the renal vein and into or through the Gerota fascia. Although this patient presented with symptoms suggesting an underlying process, more early-stage renal cell carcinomas are currently being identified incidentally because of the development and more frequent use of sensitive imaging techniques. Various treatment options are available for patients with advanced disease, including immunotherapy and many small-molecule tyrosine kinase inhibitors. However, at present, there is no evidence that any of these approaches is clearly associated with improved survival following resection of nonmetastatic disease, and they are therefore not used as adjuvant therapy.

The tyrosine inhibitors sunitinib and temsirolimus have shown significant activity against renal cell carcinoma and are used in patients with metastatic disease. However, they have no established role as adjuvant therapies following surgical resection. Although studies are ongoing, particularly trials of some of the tyrosine kinase inhibitors, the current standard of care following surgical resection is close observation.

Radiation therapy has no role in the management of patients following resection for localized renal cell carcinoma, even when surgical margins are positive.