Patients with early stage kidney cancer who had only the tumor removed experienced better survival rates than those who had the entire kidney removed, according to the results of a study published in the Journal of the American Medical Association.
Nearly 65,000 people are diagnosed with kidney cancer in the United States each year. For patients with early stage kidney cancer, partial nephrectomy (removal of only the cancerous part of the kidney) is the standard treatment; however, depending on the size of the cancer and the function of the second kidney, some surgeons may recommend radical nephrectomy (removal of the entire kidney). Although partial nephrectomy is not always possible, it offers the important advantage of preserving kidney function.
To compare long-term survival rates after partial versus radical nephrectomy, researchers from the University of Michigan Comprehensive Cancer Center evaluated data from 7,138 Medicare beneficiaries with clinical stage T1a kidney cancer treated from 1992 through 2007.
After a median follow-up of 62 months, 25.3% of patients treated with partial nephrectomy had died, compared with 41.5% of patients treated with radical nephrectomy. Patients treated with partial nephrectomy had a 46% lower risk of death.
Regardless of the type of surgery, patients had an equal chance of dying from kidney cancer, suggesting that each type of surgery was likely to cure the cancer. Kidney cancer was the cause of death for 1.9% of partial nephrectomy patients and 4.3% of radical nephrectomy patients. The survival discrepancy was found in death from any cause.
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With the increased use of x-rays and CT scans (for unrelated reasons), the identification of early stage kidney cancer has become more common—making it important to weigh the risks and benefits of partial versus radical nephrectomy. Partial nephrectomy is a more technically challenging procedure and is associated with more short-term complications. Radical nephrectomy, on the other hand, can increase the risk of chronic kidney disease and is associated with more long-term complications.
Partial nephrectomy may not be the best choice for all patients, but the results of this study indicate that it should be an important consideration in order to optimize long-term survival.
 Tan HJ, Norton EC, Ye Z, et al. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012; 307(15): 1629-1635.
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