Comparison of Partial Nephrectomy with Radical Nephrectomy in Renal Cancer

Comparison of Partial Nephrectomy with Radical Nephrectomy in Patients with Localized Renal Cell Cancer.

The most commonly performed surgery to treat renal cell cancer is radical nephrectomy. During a radical nephrectomy, an incision is made through the skin beneath the rib cage (right or left) near the muscles of the back. The whole kidney, along with the cancer, the attached adrenal gland, and the fatty tissue immediately around the kidney are removed through the incision. The lymph nodes around the kidney are often removed and examined under the microscope to determine if they contain cancer.

A partial nephrectomy only removes a portion of the kidney. Partial nephrectomies are often performed when the cancer involves both kidneys, if patients only have one kidney, or in patients with poor kidney function who could not tolerate the loss of an entire kidney. Attempts are made to remove all the cancer with a margin of normal kidney tissue.

More recently, partial nephrectomy has been used to treat patients with small cancers even if the other kidney is normal. The rationale is that 1½ kidneys are better than one. In most clinical studies, there are no more complications from partial nephrectomy than from a radical nephrectomy, but in some there has been an increase in bleeding following surgery.

Physicians at the University of California compared the results of partial nephrectomy in 146 patients with the results of radical nephrectomy in 125 patients. Most of the cancers in this study were 4 centimeters or less (an inch and a half). For patients with cancers 4 centimeters or less, there was one local recurrence among 53 patients with a partial nephrectomy and one among 52 patients with radical nephrectomy. For patients with cancers between 4 and 7 centimeters, there was one local recurrence among 10 patients with a partial nephrectomy and one among 27 treated with a radical nephrectomy. For cancers greater than 7 centimeters, the local recurrence rate was also higher after partial nephrectomy than after radical nephrectomy.

It would appear from this and other studies that patients with stage I renal cell cancer with cancers 4 centimeters or less have the same good outcome with either partial or radical nephrectomy. There is not enough information about patients with cancers between 4 and 7 centimeter in size. Patients with stage II cancers (larger than 7 centimeters) should have a radical nephrectomy if the opposite kidney is normal. These surgeons concluded that partial removal of the kidney was a more difficult operation than radical nephrectomy, but that many patients could benefit from this approach, especially those with small, easily removed cancers even when the second kidney is normal. They proposed a randomized clinical trial comparing partial nephrectomy to radical nephrectomy for treatment of localized renal cell cancer would be necessary to determine whether both therapies are equally effective.

(Journal of Clinical Oncology, Vol 17, No 9,pp 2868-2875, 1999)

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