American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard of care for patients post-surgical resection for nonmetastatic renal cell carcinoma?

1. Chemotherapy

2. Close observation

3. Radiation therapy

4. Immediate repeat imaging

The correct answer is: Close observation

Close observation is the standard of care for patients after surgical resection for nonmetastatic renal cell carcinoma. This approach is based on the understanding that patients who have undergone surgery for localized disease are often at risk for recurrence, but the majority do not require immediate additional treatment following the procedure. Rather than implementing aggressive adjuvant therapies such as chemotherapy or radiation, which have not shown consistent benefits in improving survival in this context, the focus is placed on monitoring the patient for any signs of recurrence. This typically includes regular follow-up appointments and imaging studies as indicated, which allows for timely intervention if a recurrence is detected. In contrast, options like chemotherapy or radiation therapy are not standard practices following the surgical removal of renal cell carcinoma, particularly in nonmetastatic cases, since these modalities are primarily utilized in advanced or metastatic situations. Additionally, while repeat imaging may be part of follow-up care, it is not typically considered an immediate necessity after surgery and is not the standard of care itself. Thus, the approach of close observation aligns with current guidelines and has been shown to be the most effective in managing this patient population.