Table1. Summarized risk-based suggested approaches (and alternative options) for renal cell carcinoma during the COVID-19 pandemic.

Stage/clinical presentation	Suggestion (s)	Alternative(s)
cT1aN0M0 (<4.0cm) and complex renal cysts (BosniaK III/IV)	Active Surveillance and postponed SurgeryΨ	Thermal ablation Obs.: For patients refractory or unavailable for surveillance.
cT1b-T2 N0M0	SurgeryΨ	Surveillance and delayed surgeryΨ (only for selected cT1b and cT2a < 7.0 cm) Obs.: CT * ou MRI * after 90 days in recommendable) Obs.: A renal biopsy could be discussed before decision between surgery or surveillance.
≥cT3 and or N+, venous thrombus	Upfront SurgeryΨ	Individualized discussion or tumor board discussion
Low Risk Metastatic	Systemic Therapy (TKI or TKI+ICI) and postponed cytorreductionΨ	Active surveillance for selected cases
Intermediate and poor Risk Metastatic	Systemic Therapy (ICI+ICIC, or ICI+ TKI)	Alternative drugs doses or scheduling intervals between applications.
		For selected intermediate risks patients with satisfactory response after systemic therapy delayed cytoreductionΨ can be discussed.
Special conditions
Local Recurrences (small asymptomatic lesion)	Surveillance	Thermal ablation
Local Recurrences (symptomatic or locally invasive lesion)	Wide surgeryΨ	Systemic Therapy and delayed postponed surgery.
		Individualized discussion or tumor board
Hereditary RCC	Follow usual guidelines (surgeryΨ if >3.0 cm, except for HLRRCC syndrome (prompt resection)	Individualized discussion or tumor board discussion

^*CT-Computerized Tomography;

** MR -Magnetic Resonance

# All therapeutic decisions must be preceded by a specific informed consent and based on shared decisions. Tumor boards might support decision in difficult cases.

Minimally invasive surgeries and early hospital discharge are desirable, even possible. Health professionals must not forget in using their personal protective equipment, perform safe surgery (as for open, as for minimally invasive procedures) ( 27 ).