Among patients under the age of 65 with small, localized renal tumors, radical nephrectomy may result in worse overall survival than partial nephrectomy. These results were published in The Journal of Urology.
The kidneys are each filled with tiny tubules that clean and filter the blood-the process that removes waste and makes urine. Renal cell cancer (RCC) is a malignancy involving these tubules of the kidney.
Treatment of patients with renal cell cancer generally includes surgery unless patients are too ill to tolerate the procedure. Two common types of surgery are radical nephrectomy and partial nephrectomy.
A radical nephrectomy refers to the complete removal of the involved kidney, adjacent fat, adrenal gland, and/or any involved lymph nodes or major vasculature. A partial nephrectomy refers to the removal of the tumor and some surrounding normal tissue.
To describe outcomes after each type of surgery, researchers conducted a study among 648 patients with single, small (4 cm or less), localized renal cell tumors. A majority of the patients had renal cell cancer, but 122 of the patients had benign (noncancerous) growths. Two hundred and ninety patients underwent a radical nephrectomy and 358 underwent a partial nephrectomy.
- Among all patients combined, survival did not vary significantly by type of surgery. In the subset of patients under the age of 65, however, risk of death did vary by type of surgery.
- Among patients under the age of 65, risk of death was more than twice as high among patients who underwent a radical nephrectomy than among patients who underwent a partial nephrectomy. Ten-year overall survival was 82% among patients treated with radical nephrectomy and 93% among patients treated with partial nephrectomy.
- The increased risk of death among younger patients who underwent a radical nephrectomy persisted even after accounting for factors such as other chronic health problems, symptoms at presentation, preoperative creatinine level, and type of tumor (cancerous versus benign).
The researchers conclude that compared with partial nephrectomy, radical nephrectomy may result in worse survival among younger patients with single, small renal cell tumors. They note "…these data provide further support for [partial nephrectomy] as the standard of care for managing most small renal masses."
Reference: Thompson RH, Boorjian SA, Lohse CM et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. The Journal of Urology. 2008;179:468-473.
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