Type of Surgery Affects Long-Term Survival in Early-Stage Kidney Cancer
Older patients with early-stage kidney cancer lived longer if only the tumor, and not the entire kidney, was removed, according to a new study. Cancer-specific survival, however, was similar regardless of whether patients had a partial nephrectomy or a radical nephrectomy. The findings were published April 18 in JAMA.Dr. David Miller of the University of Michigan Comprehensive Cancer Center and his colleagues used NCI’s SEER-Medicare Linked Database to analyze data from approximately 7,100 Medicare beneficiaries who had surgical treatment for kidney tumors that were 4 cm or smaller (stage T1a) between 1992 and 2007.
The authors used a statistical model to adjust for differences between the two treatment groups. This analysis showed that patients who had a partial nephrectomy had a 46 percent lower risk of death from any cause. Based on the model, the research team estimated that one death was averted during 8 years of follow-up for every seven patients treated with partial nephrectomy instead of radical nephrectomy.
Radical nephrectomy can substantially increase the risk of developing chronic kidney disease, studies have shown. The survival difference seen in the JAMA study and others, explained Dr. Miller, may be due to a greater frequency of long-term complications from chronic kidney disease, including cardiovascular adverse events, among patients who received radical surgery. He cautioned, however, that further research is needed to demonstrate whether complications are, in fact, the cause of the survival difference.
Although clinical guidelines now recommend partial nephrectomy for most patients with early-stage kidney cancer, the procedure has not been widely adopted. In this study, only 27 percent of the patients had undergone a partial nephrectomy. Choosing which type of surgery to have, Dr. Miller acknowledged, can involve a trade-off because partial nephrectomy is more technically challenging than radical nephrectomy and can be associated with more short-term complications.
Active surveillance—forgoing immediate treatment after diagnosis and closely monitoring the tumor—is another option for some patients. And minimally invasive robotic surgery is also increasingly being used to perform partial nephrectomy, added Dr. Miller. “From my view, the robotic platform has made partial nephrectomy a much more technically accessible procedure.”
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