Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?
OBJECTIVE
To investigate whether radical nephrectomy (RN) and nephron-sparing surgery (NSS) for T1 renal cell carcinoma influence renal function, oncological outcome or survival rate.


METHODS
A retrospective study was performed, including 290 nephrectomies for tumours of a diameter of less than 7 cm; 174 radical nephrectomies were compared to 116 nephron-sparing surgeries. Preoperative and pathological data were compared between the two groups. The glomerular filtration rate was estimated using the abbreviated Modification of Diet and Renal Disease (MDRD4) study equation. The evolution of renal function was analysed from 6 months to 4 years after surgery, and the oncological outcomes were evaluated by means of cancer and non-cancer survival curves.


RESULTS
The results showed a major impairment in renal function in the RN group compared to those who underwent NSS (25 vs 7 ml/min/1.73 m², 6 months after surgery), a difference that was maintained over time. Moreover, patients undergoing RN had a greater chance of developing renal failure. Overall, the survival curves showed a higher mortality rate for the RN group (p = 0.034), although the cancer-specific mortality rate did not show any statistically significant differences (p = 0.079).


CONCLUSIONS
For stage T1 renal cortical tumours, NSS should, whenever possible, be regarded as the primary therapeutic option, given that it obtains similar oncological outcomes to RN and preserves renal function, which seems to translate into a lower overall mortality rate.
Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain. josemedinapolo@telefonica.net
José
J
Medina-Polo
Javier
J
Romero-Otero
Alfredo
A
Rodríguez-Antolín
Mario
M
Domínguez-Esteban
Juan
J
Passas-Martínez
Felipe
F
Villacampa-Aubá
David
D
Lora-Pablos
Agustín
A
Gómez De La Cámara
Rafael
R
Díaz-González
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000502:physiology* / Q000601:surgery; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000473:pathology / Q000502:physiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome