The most commonly performed surgery to treat renal cell cancer is radical nephrectomy. During a radical nephrectomy, an incision is made through the skin beneath the rib cage (right or left) near the muscles of the back. The whole kidney along with the cancer, the attached adrenal gland, and the fatty tissue immediately around the kidney are removed through the incision. The lymph nodes around the kidney are often removed and examined under the microscope to determine if they contain cancer.
A partial nephrectomy only removes a portion of the kidney. Partial nephrectomies are often performed when the cancer involves both kidneys, if patients only have one kidney, or in patients with poor kidney function who could not tolerate the loss of an entire kidney. Attempts are made to remove all the cancer with a margin of normal kidney tissue.
More recently, partial nephrectomy has been used to treat patients with small cancers even if the other kidney is normal. The rationale is that 1½ kidneys are better than one. In most clinical studies, there are no more complications from partial nephrectomy than from a radical nephrectomy, but in some there has been an increase in bleeding following surgery.
Physicians in Belgium reported their results of partial nephrectomy in patients with localized renal cell cancer. A total of 76 patients underwent the kidney sparing surgery, which was required in 25 because of poor kidney function and was elected over more extensive surgery in 51 patients. Cancer size varied from 1-15 centimeters (less than 1-6 inches). Eight patients had postoperative complications, most often bleeding. No patient experienced a local recurrence but 3 developed distant cancer recurrence.
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These surgeons concluded that partial removal of the kidney was a more difficult operation than radical nephrectomy but that many patients could benefit from this approach, especially those with small easily removed cancers even when the second kidney is normal. They proposed a randomized clinical trial comparing partial nephrectomy to radical nephrectomy for treatment of localized renal cell cancer would be necessary to determine whether both therapies are equally effective.
(Journal of Urology; Vol 160, No 3, Pt 10, pp 674-678, 1998)
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