Partial kidney removal under-used for small tumors

By Megan Rauscher

NEW YORK (Reuters Health) - Patients with small kidney tumors are more likely to have "radical nephrectomy" (i.e., complete surgical removal of the affected kidney) than partial nephrectomy, despite evidence showing that the two approaches are equally effective, new research shows.

"Just as lumpectomy can be less invasive but as effective as mastectomy for treating breast cancer, people with kidney cancer should be aware that partial nephrectomy is not only an option, but may be a better option than radical nephrectomy in many circumstances because it may help preserve kidney function in patients with renal tumors, Dr. William Huang, of New York University School of Medicine, said in a written statement.

"We need to do a better job of educating both patients and physicians about this topic," he added.

Partial nephrectomy has been shown to be equivalent to radical nephrectomy in tumors less than 4 centimeters and, in some tumors, even up to 7 centimeters, Huang noted.

He and colleagues analyzed data from a US cancer registry to identify pre-surgery factors that differed between 2,547 patients who had radical nephrectomy and 556 who had partial nephrectomy.

"We found that over half of patients with newly diagnosed kidney tumors are actually amenable to receiving a partial nephrectomy just based on the tumor size alone," Huang said.

In spite of this, fewer than one in five patients are actually being offered partial nephrectomy. "Four out of five patients with small kidney tumors are having their entire kidney removed," Huang said.

He presented the findings this week at the 2008 Genitourinary Cancers Symposium sponsored by the American Society of Clinical Oncology, American Society of Therapeutic Radiology and Oncology, and the Society of Urologic Oncology.

"For unclear reasons," Huang noted, older patients, patients with a history of cerebrovascular disease, such as stroke, and women are more likely to have the radical surgery.

Those who are more likely to have partial kidney removal include those with a prior history of chronic kidney disease, "which makes sense," Huang said, and those who received treatment at a later date, "suggesting that more and more physicians are now performing partial nephrectomy instead of radical nephrectomy for small kidney tumors."