title: Adverse health outcomes associated with surgical management of the small renal mass.
abstract: OBJECTIVE
  Partial and radical nephrectomy are treatments for the small renal mass. Partial nephrectomy is considered the gold standard as it may protect against renal dysfunction compared to radical nephrectomy. However, both treatments may cause adverse health outcomes.
  
  
  METHODS
  A matched cohort study was performed using the SEER (Surveillance, Epidemiology and End Results)-Medicare data set. Individuals treated with partial or radical nephrectomy for 4 cm or smaller nonmetastatic renal cell carcinoma were compared to 2 control groups (nonmuscle invasive bladder cancer and noncancer). A greedy algorithm matched surgical groups to controls. Medicare claims were examined for renal, cardiovascular and secondary cancer events.
  
  
  RESULTS
  Patients who underwent partial nephrectomy (1,471) and radical nephrectomy (4,299) were matched to controls. The time to event model demonstrated an increased risk of renal events for both treatments. Compared to the bladder cancer control and noncancer control groups, radical nephrectomy hazard ratios for renal events were 2.415 (p <0.0001) and 6.211 (p <0.0001), respectively, while partial nephrectomy hazard ratios were 1.513 (p <0.0001) and 4.926 (p <0.0001), respectively. Secondary cancers were increased for partial nephrectomy and radical nephrectomy compared to both control groups (p <0.0001). Cardiovascular events were increased for both treatments compared to noncancer controls (p <0.0001), but not compared to bladder cancer controls.
  
  
  CONCLUSIONS
  Partial nephrectomy and radical nephrectomy may lead to adverse health outcomes. Compared to controls, partial nephrectomy and radical nephrectomy are associated with worsened renal outcomes. The increase in secondary cancers and cardiovascular events with both treatments is notable, and requires further investigation. Further research should investigate if active surveillance of the appropriately selected small renal mass limits adverse health outcomes.
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, Connecticut. Electronic address: brian.shuch@yale.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Shuch
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Hanley
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lai
authors.affiliation: Department of Urology, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Vourganti
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Claude M
authors.initials: CM
authors.lastname: Setodji
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: Department of Epidemiology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Wong-Ho
authors.initials: WH
authors.lastname: Chow
authors.affiliation: Department of Urology, UCLA School of Medicine, Los Angeles.
authors.forename: Chris S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology; D057832:Watchful Waiting
keywords: AS; BCC; CCI; CKD; CSS; Charlson comorbidity index; ESRD; HTN; NCC; PN; RCC; RN; SRM; active surveillance; bladder cancer control; cancer specific survival; chronic kidney disease; end stage renal disease; hypertension; kidney neoplasms; nephrectomy; noncancer control; partial nephrectomy; radical nephrectomy; renal cell carcinoma; small renal mass; watchful waiting