WASHINGTON, DC USA (UroToday.com) - There is clear documentation that partial nephrectomy is underutilized for small renal masses and instead patients are having the entire kidney removed.
From 2002 to 2006 the use of partial nephrectomy has increased to 40%, but at tertiary centers it is over 85%. Younger age and more recent year of surgery were associated with greater likelihood of partial nephrectomy. Nephrectomy induces chronic kidney disease, especially over a 10-year time span following surgery. As GFR declines, there are increased rates of cardiovascular events and decreased survival. Cardiac specific survival decreases as eGFR decreases. Overall survival is also better in those undergoing partial nephrectomy. However, an EORTC randomized Phase III trial showed that those treated with radical nephrectomy had better overall survival. It is unclear if selection bias or limited number of events account for observations in the studies he showed. Economic cost analysis suggests that partial nephrectomy is more expensive than radical nephrectomy, but CKD results in greater costs for radical nephrectomy. Return to full activity was similar in an analysis compared radical and partial nephrectomy.
Presented by William Huang, MD at the Society for Basic Urologic Research (SBUR)/Society of Urologic Oncology (SUO) joint meeting during the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.
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