Tissue-Sparing Tumor Surgery Offers Better Long-Term Kidney Function

A new study has found that patients with kidney tumors larger than four centimeters are much more likely to enjoy good long-term renal function if they undergo nephron-sparing surgery (NSS), rather than radical nephrectomy (RN).

Researchers at Johannes Gutenberg University (Mainz, Germany) conducted a study involving 829 patients with renal tumors over four centimeters in size that were treated by either RN (641 patients) or NSS (188 patients) between 1981 and 2007. After excluding patients with imperative indication and metastases, the researchers retrospectively identified 81 young patients (less than 55 years) and 85 elderly patients (aged 65 years and over). In all, 36 and 33 patients underwent NSS and 45 and 52 patients underwent RN in the young and elderly group, respectively. Preoperative and periodically postoperative serum creatinin values were used to estimate glomerular filtration rate (GFR); clinical characteristics, complications, and renal function were compared between age groups and surgical approaches.

The results showed that the median tumor size in young patients was larger compared with that of elderly patients. The complication rates did not differ between the age groups or between NSS and RN. Chronic kidney disease after RN or NSS occurred in 31.1% and 15.5% for young patients (respectively), and in 50.9% and 24.2% in elderly patients (respectively), until last available follow-up obtained after a median five and a half years. Overall survival did not significantly differ between NSS and RN in both young and elderly patients. The study was published in the February 2011 issue of British Journal of Urology International (BJUI).

"It is important to choose the type of surgery that patients receive for kidney tumors based on a number of factors, such as tumor features, biological age, other illnesses and the patient's wishes and social support; the patient's actual age should not be a factor in whether they receive the surgery,” said lead author Frederik Roos, MD, of the department of urology. "We believe that our research shows that, if the factors we have outlined above make NSS feasible, it is the best surgical option for younger patients and carefully selected older patients with a kidney tumor of four centimeters or more.”

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Johannes Gutenberg University