To discuss, providing also a structured report, the role of radiologists in different clinical scenarios: Localised disease (nephron sparing vs radical nephrectomy?); Locally advanced disease (surgical procedure or neo-adjuvant therapies?); Response assessment in neoadjuvant treatments of locally advanced Renal Cell carcinoma (RCC).

In the last decades, the treatments of RCC has significantly evolved: both new nephron-sparing surgical techniques and innovative systemic therapy in advanced RCC were developed. Otherwise several authors have shown that RCC has an high recurrence rate (20~30%) after surgical treatment highlighting the need of prognostic factors [1,2,3]. For these reasons several revisions of TNM staging which reflects the advances in treatment and prognosis were made. Major changes were made in the 7th edition of Tumor-Node-Metastasis (TNM) staging system regarding especially T3 category: renal vein...

Role of radiologists in: 1. Localised disease This section concerns tumour limited to kidney (T1-T2): TNM 2009 (7th edition) is the same in AJCC/TNM 2017 (8th edition). Because of expanding indications of partial nephrectomy, several authors [4,5,6] have tried to validate preoperative scoring to quantify tumour size, location and depth based on preoperative imaging findings. American Urological Association guidelines established that partial nephrectomy for management of T1 renal mass is possible when technically feasible [7]. Otherwise, partial nephrectomy can be a surgical approach also for...

Correct preoperative radiologic RCC staging provides information critical for an adequate patient selection. The radiologists should be aware of inclusion criteria for nephron-sparing surgery, different surgical approach and of response assessment in systemic therapies.

1. Crispen, P. L. et al. Lymphnode dissection at the time of radical nephrectomy for high-risk clear cell renal cell carcinoma: indications and recommendations for surgical templates. Eur Urol 2011; 59, 18–23 2. Ljungberg, B. et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015; 67, 913–924 3. MacLennan, S. et al. Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol 2012; 61, 972–993, 4. Simmons MN, Ching CB, Samplaski MK, et al. Kidney tumor location measurement...