Cancer Surgery Options Not Clear Cut

Kidney cancer surgical approaches impact survival differently

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Figuring out the best course for cancer treatment can be complicated. In addition to dealing with the cancer itself, the long-term impacts of treatment need to be considered. Longer life is obviously a key goal.

The best way to treat kidney cancer is now being questioned. A recent study found that surgically removing only the diseased part of the kidney may not be better than removing the whole kidney.

Researchers discovered that patients in this study who had the whole kidney removed lived longer than those who had only part of the organ removed.

"Ask your surgeon to explain the risks and benefits of your surgery."

Emelian N. Scosyrev, PhD, an epidemiologist and assistant professor of urology at the University of Rochester Medical Center (URMC), led this study that looked at data on more than 500 kidney cancer patients.

Kidney cancer will be diagnosed in about 65,000 Americans this year.

The aim of this study was to track renal (kidney) function and survival of patients who had been randomly assigned to have either total removal of the kidney (radical nephrectomy, or RN) or partial removal (nephron-sparing surgery, or NSS) of the kidney.

All of the participants had small kidney cancers, and their other kidney was functioning normally at the time of surgery.

Survivors were followed for an average of seven years after surgery to evaluate kidney function, and some participants were followed for roughly nine years to analyze how the surgeries affected survival.

Individuals who had received a partial nephrectomy had a 20 percent lower incidence of moderate kidney dysfunction, compared to patients whose entire kidney had been removed.

Kidney failure, which occurs when the kidney stops functioning altogether, was the same for both groups — about 1.5 percent.

However, survival rates were lower in those who had NSS. “Among the 273 patients randomized to RN, four patients died from kidney cancer and 46 died from other causes. Among the 268 patients randomized to NSS, eight patients died from kidney cancer and 59 died from other causes,” the authors reported.

The authors noted that 78 percent of participants were still alive at the last follow-up (9.3 years), and that survival rates may change with longer follow-up.

"Our data appears to seriously question the assumption that by saving kidney tissue, we are helping patients avoid future kidney failure," said Edward Messing, MD, chair of Urology at URMC.

Kidney cancer specialist Alexander Kutikov, MD, associate professor of Urologic Surgical Oncology at Fox Chase Cancer Center in Philadelphia, pointed out that all study participants had normal functioning second kidneys.

“The decision between a radical and a partial nephrectomy, just like most decisions in medicine, boils down to a balance of risk. Do the slightly higher risks of a more complex surgery (i.e., partial nephrectomy) justify the theoretical benefits for kidney tissue preservation?"

"These data suggest that for patients with normal contralateral [second] kidney for whom additional surgical intensity is not trivial (e.g., the elderly with complex renal masses), radical nephrectomy is a robust option,” said Dr. Kutikov, who was not involved in the study.

“Nevertheless, partial nephrectomy, especially for small and anatomically simple renal masses, should remain the surgical reference standard for most individuals, since preservation of renal tissue can be thought of as an 'insurance policy' not only against future renal functional decline, but also against the possibility of developing a tumor in the opposite kidney,” Dr. Kutikov told dailyRx News.

Findings from this study were published in the July issue of the journal European Urology.

This study was supported by Fond Cancer (FOCA) from Belgium. No conflicts of interest were disclosed.

Review Date: 
July 30, 2013
Last Updated:
December 31, 2013