Nephron-sparing surgery preserves renal function in kidney cancer patients
MedWire News: Patients with large kidney tumors are more likely to maintain long-term renal function if they undergo nephron-sparing surgery (NSS) rather than radical nephrectomy (RN), German researchers report.
Frederik Roos and colleagues, from Johannes Gutenberg University in Mainz, compared renal function, perioperative morbidity, and overall survival (OS) in 81 young patients (age <55 years) and 85 elderly patients (aged >65 years) treated with RN or NSS for renal tumors larger than 4 cm.
"Overall survival and complication rates were similar between the two [treatment] groups, but long-term kidney function, which is very important to overall health and quality of life, was much better in the patients who had received NSS," said Roos.
"In RN the surgeon removes the whole kidney and the tissue around it, while in NSS the surgeon removes the cancer and part of the kidney surrounding it so that the patient still has some working kidney left after the operation" Roos explained.
In all, 36 young and 33 elderly patients underwent NSS, while 45 young and 52 elderly patients underwent RN.
The researchers report that following RN and NSS, a respective 31.1% and 15.5% of the younger patients, developed chronic kidney disease (CKD) - defined as a glomerular filtration rate of less than 60 ml/min/1.73 m2 - during a median follow-up period of 5.7 years.
The CKD incidence among the elderly patients who underwent RN and NSS was 50.9% and 24.2%, respectively, during a median follow-up period of 5.5 years.
Five-year OS rates did not differ significantly between RN and NSS, at 91.3% versus 91.8% in the younger patients, and 88.9% versus 72.1% in the elderly patients.
Furthermore, complications such as urinary fistula, spleen damage, urinary retention, and pulmonary edema, occurred at a similar rate for both procedures and did not differ by age group despite a significantly higher rate of baseline comorbidites among elderly relative to younger patients. None of the patients died as a result of the surgery.
"Our results show that 76% of older patients enjoyed good long-term kidney health with NSS as did 85% of younger patients.
"This is important as loss of kidney function is also associated with other health issues, including higher incidence of cardiovascular disease and cardiac deaths and reduced function in other organs," said Roos.
The researchers conclude in BJU International that "the option of surgical excision with curative intent for renal cell carcinoma should not be withheld from patients because of their age."
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By Laura Dean