Research Activities January 2013, No. 389
Partial kidney removal offers survival advantage for elderly patients with small tumors
Elderly Health/Long-Term Care
The number of patients diagnosed with small kidney tumors has increased considerably over the last 2 decades. As a result, partial removal of the affected kidney has replaced complete removal as the standard treatment in order to preserve kidney function. A new study shows that patients treated with partial rather than total removal of the kidney had a significantly lower risk of dying of kidney cancer.
The researchers retrospectively studied the outcomes of 7,138 Medicare patients with early-stage kidney cancer. Thirty-seven (1.9 percent) patients who underwent partial kidney removal died compared to 222 (4.3 percent) of those whose complete kidney was removed. Based on a predicted survival difference of 15.5 percentage points at 8-year follow-up, the researchers estimated that one life would be saved for every seven patients treated with partial rather than total kidney removal.
Although these findings contradict the results of an earlier clinical trial that found a survival benefit for those treated with total kidney removal, the researchers believe that this is because partial kidney removal was much less widely used in the period covered by the clinical trial. At that time, physicians were much less skilled in its intricacies, and the patient population it was applied to differed considerably from those receiving partial kidney removal in the period covered by the newer study. This study was supported in part by the Agency for Healthcare Research and Quality (HS18346).
See "Long-term survival following partial vs. radical nephrectomy among older patients with early-stage kidney cancer" by Hung-Jui Tan, MD, Edward C. Norton, PhD, Zaojun Ye, MS, and others in the April 18, 2012, Journal of the American Medical Association 307(15), pp. 1629-1635.