Type of Surgery Affects Long-Term Survival in Early-Stage Kidney Cancer
Older people with early-stage kidney cancer lived longer if only the tumor, and not the entire kidney, was removed, according to a new study published in JAMA, the Journal of the American Medical Association. Cancer-specific survival, however, was similar regardless of whether people had a partial nephrectomy (kidney removal) or a radical nephrectomy.
Dr. David Miller of the University of Michigan Comprehensive Cancer Center and his colleagues analyzed data from people who had surgical treatment for kidney tumors that were 4 cm or smaller. This analysis showed that people who had a partial nephrectomy had a 46 percent lower risk of death from any cause. The research team estimates that one death was averted during eight years of follow-up for every seven people treated with partial nephrectomy instead of radical nephrectomy.
Radical nephrectomy can substantially increase the risk of developing chronic kidney disease, studies have shown.
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, explains Dr. Miller, may be due to a greater frequency of long-term complications from chronic kidney disease, including cardiovascular adverse events, among people who received radical surgery. He cautions, 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 people with early-stage kidney cancer, the procedure has not been widely adopted. Choosing which type of surgery to have, Dr. Miller acknowledges, can involve a trade-off because partial nephrectomy is more technically challenging than radical nephrectomy and can be associated with more short-term complications.
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This article was originally published in Coping® with Cancer magazine, May/June 2012.