Researchers from the Mayo Clinic have reported that radical nephrectomy in patients under the age of 65 with small, localized renal tumors, may result in worse overall survival than partial nephrectomy. These results were published in the February, 2008 issue of The Journal of Urology.¹

Treatment of patients with renal cell cancer generally includes surgery unless patients are too ill to tolerate the procedure. Two common types of surgery are radical nephrectomy and partial nephrectomy. The relative merits of these two approaches are still being investigated. A previous study has shown that in patients undergoing surgery for the treatment of small kidney tumors, radical nephrectomy was linked with a higher risk of chronic kidney disease than partial nephrectomy.²

The current study involved 648 patients with single, small (4 cm or less), localized renal cell tumors. A majority of the patients had renal cell cancer, but 122 of the patients had benign tumors. Two hundred and ninety patients underwent a radical nephrectomy and 358 underwent a partial nephrectomy.

• Among all patients combined, survival did not vary significantly by type of surgery. In the subset of patients under the age of 65, however, risk of death did vary by type of surgery.
• Among patients under the age of 65, risk of death was more than twice as high among patients who underwent a radical nephrectomy than among patients who underwent a partial nephrectomy. Ten-year overall survival was 82% among patients treated with radical nephrectomy and 93% among patients treated with partial nephrectomy.
• The increased risk of death among younger patients who underwent a radical nephrectomy persisted even after accounting for factors such as other chronic health problems, symptoms at presentation, preoperative creatinine level, and type of tumor (cancerous versus benign).

The researchers conclude that compared with partial nephrectomy, radical nephrectomy may result in worse survival among younger patients with single, small renal cell tumors. They note “…these data provide further support for [partial nephrectomy] as the standard of care for managing most small renal masses.”

Comments: These two studies strongly support partial nephrectomy over radical nephrectomy for treatment of small renal cancers.

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¹ Thompson RH, Boorjian SA, Lohse CM et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. The Journal of Urology. 2008;179:468-473

² Huang WC, Levey AS, Serio AM et al. Chronic Kidney Disease after Nephrectomy in Patients with Renal Cortical Tumours: A Retrospective Cohort Study. Lancet Oncology. 2006;7:735-40.