Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses.
OBJECTIVE
Radical nephrectomy has traditionally been preferred to partial nephrectomy in patients with localized renal cell cancer because of its simplicity and established cancer control. Recent data suggest that these patients have significant competing risks of death, some of which may be increased by chronic renal insufficiency. Therefore, we compared overall survival, cancer specific survival and cardiac specific survival in patients undergoing partial or radical nephrectomy for cT1b tumors.


METHODS
From 1999 to 2006, 1,004 patients with renal masses between 4 and 7 cm underwent extirpative surgery, partial nephrectomy (524) or radical nephrectomy (480). We generated a propensity model based on preoperative patient characteristics, and then modeled survival with the additional variables of pathological stage and new baseline renal function.


RESULTS
On multivariate analysis cancer specific survival was equivalent for patients treated with partial nephrectomy or radical nephrectomy. Those patients undergoing radical nephrectomy lost significantly more renal function than those undergoing partial nephrectomy. The average excess loss of renal function observed with radical nephrectomy was associated with a 25% (95% CI 3-73) increased risk of cardiac death and 17% (95% CI 12-27) increased risk of death from any cause on multivariate analysis.


CONCLUSIONS
Partial nephrectomy offers cancer specific survival equivalent to that of radical nephrectomy and is technically feasible in at least 50% of patients with cT1b tumors. Preservation of renal function was significantly better in patients treated with partial nephrectomy. Postoperative renal insufficiency was a significant independent predictor of overall and cardiovascular specific survival, and efforts should be made to limit the renal function loss associated with surgery for localized renal masses.
Weight
Christopher J
CJ
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Larson
Benjamin T
BT
Fergany
Amr F
AF
Gao
Tianming
T
Lane
Brian R
BR
Campbell
Steven C
SC
Kaouk
Jihad H
JH
Klein
Eric A
EA
Novick
Andrew C
AC
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate