Posted on May 25th, 2011 by
Use of partial nephrectomy (surgical removal of only the cancerous part of the kidney) has increased in recent years among patients with small kidney tumors, but further increases may be warranted. Trends in partial nephrectomy were evaluated in three studies presented at the 106th annual meeting of the American Urological Association (AUA).
For patients with small, localized kidney cancer, surgery involves either a partial nephrectomy (removal of only the cancerous part of the kidney) or a radical nephrectomy (removal of the entire kidney). Although partial nephrectomy is not always possible, it offers the important advantage of preserving kidney function. Partial nephrectomy may also be referred to as “nephron-sparing” surgery.
To evaluate trends in the use of partial nephrectomy in the United States, researchers collected information about more than 48,000 patients with non-metastatic kidney cancer treated between 1998 and 2007. Use of partial nephrectomy increased substantially over this time period, from 7% in 1998 to 26% in 2007. Use of partial nephrectomy was variable, however, and was more common at institutions that treat large numbers of kidney cancer patients.
A second study evaluated use of partial nephrectomy among the elderly. The researchers found that partial nephrectomy was less common among older people (those age 75 or older) than among younger people, despite the fact that older patients often have other health conditions and could benefit from kidney preservation.
Finally, a study evaluated trends in laparoscopic surgery. Laparascopic surgery is a minimally invasive approach that involves several small incisions rather than the single large incision of open surgery. Laparoscopic surgery may be used for either radical nephrectomy or partial nephrectomy. During the time period of the study (1995-2005), rates of laparascopic radical nephrectomy increased to a much greater extent than rates of either laparascopic or open partial nephrectomy. As recently as 2005, 77% of patients with tumors confined to the kidney continued to undergo radical nephrectomy.
In a prepared statement, a spokesperson for the American Urological Association noted “In recent years, we’ve moved further away from radical nephrectomy to treat small renal masses and have adopted a nephron-sparing approach in order to preserve kidney function and potentially prevent future kidney-related comorbidities such as diabetes and high blood pressure. Though progress is being made in terms of educating physicians about what can be done to preserve kidney function, many still have not adopted a nephron-sparing approach.”
Patients with early-stage kidney cancer may wish to talk with their physician about whether partial nephrectomy is an option.
 Kates M, Badalato G, Pitman M et al. The overuse of nephron-wasting radical nephrectomy in the elderly: an analysis of trends in the United States population from 1998-2007. Presented at the 106th Annual Scientific Meeting of the American Urological Association (AUA). Washington, DC. May 14-19, 2011. Abstract 1668.
 Smaldone M, Kutikov A, Egleston B et al. Has a minimally invasive approach become more important than nephron preservation in the management of the clinically localized renal mass? Presented at the 106th Annual Scientific Meeting of the American Urological Association (AUA). Washington, DC. May 14-19, 2011. Abstract 66.
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