Removing Part Not All of Kidney Favored for Small Tumors

By Anthony J. Brown, MD

NEW YORK JAN 21, 2008 (Reuters Health) - New research indicates that the overall survival of small (pT1a) renal masses in younger patients is improved when partial rather than radical nephrectomy is performed.

"Previous studies have tried to show that partial nephrectomy is equivalent to radical nephrectomy with respect to cancer-specific survival. We looked at overall survival and suggest for the first time that removing the entire kidney for small renal masses may be detrimental compared with removing just the tumor and sparing the normal part of the kidney," lead author Dr. R. Houston Thompson told Reuters Health.

Dr. Thompson and colleagues from the Mayo Clinic in Rochester, Minnesota, analyzed data from 648 patients who underwent nephrectomy for a renal mass of 4 cm or less between 1989 and 2003. Two hundred ninety patients underwent radical and 358 underwent partial nephrectomy.

During a median follow-up period of 7.1 years, 146 patients died, according to the report in The Journal of Urology for February.

In the overall analysis, the type of nephrectomy had no significant effect on mortality from any cause.

However, when the analysis was stratified according to age, the authors found that among patients younger than 65 years old, those who underwent radical nephrectomy had more than twice the risk of death from any cause than those who underwent partial nephrectomy.

Moreover, this association held true after accounting for year of surgery, preoperative creatinine, Charlson-Romano index, symptoms at presentation, diabetes at presentation and histology.

"Our results support the growing body of literature that partial nephrectomy is the new gold-standard for small renal tumors. Radical nephrectomy, which has been the gold-standard for over 30 years, may be over-treatment," Dr. Thompson said.

"Most patients with small renal masses should be at least offered a partial nephrectomy -- it may save their life in the long-term," he emphasized.

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