Child/Adolescent Health

Kidney-sparing surgery for children with renal tumors has equivalent in-hospital results to kidney removal surgery

It is widely accepted that, when feasible, partial removal of the kidney (nephron sparing surgery [NSS]), is preferable to complete removal of the kidney (radical nephrectomy [RN] for the treatment of kidney tumors in adults. In children, RN is more frequently used because of the relatively large size of the tumor and technical difficulty of NSS for most pediatric kidney tumors. However, recent research suggesting that adults undergoing RN may have decreased long-term survival compared with NSS patients has prompted a reconsideration of the role of NSS in children.
Among 1,235 children with kidney tumors who received either RN or NSS, patients in either group had similar median comorbidity scores, in-hospital charges, and surgical complication rates, according to a team of researchers from Children's Hospital in Boston. The researchers suggest that NSS may be performed in well-selected children with malignant renal tumors without significantly increasing their hospital charges, length of stay, or surgical complication rates. However, they further advise that implementation of management changes in children with malignant kidney tumors would be premature, since long-term data on oncological outcomes are lacking.
Data for the study came from 41 children's hospitals that treated the 1,235 children between 2003 and 2009. In this group, 91 percent received RN and 9 percent received NSS. This study was supported in part by the Agency for Healthcare Research and Quality (T32 HS000063).
See "Contemporary use of nephron-sparing surgery for children with malignant renal tumors at freestanding children's hospitals" by Jonathan C. Routh, M.D., M.P.H., Dionne A. Graham, Ph.D., Carlos R. Estrada, M.D., and Caleb P. Nelson, M.D., M.P.H., in Urology 78, pp. 422-426, 2011.