Open Partial Nephrectomy Essential but Underutilized Operation

Newswise — Paul Russo M.D., Attending Surgeon Urology Service at Memorial Sloan Kettering Cancer Center in New York, New York presented at the 2007 Annual Meeting of the New York Section of the AUA. Dr. Russo indicated that radical nephrectomy (RN) should no longer be considered the gold standard for stage T1 (<7 cm) renal cell cancer. Dr. Russo reported that data reveals that in a study by MSKCC, Mayo Clinic, MDACC, UCLA, Cleveland Clinic, greater than 60% of patients with a kidney tumor undergo a partial nephrectomy (PN). Whereas, a study by Hollenback et al. from the University of Michigan (Urology 67:254, 2006) revealed that in a nationwide inpatient sample of 54,069 patients undergoing kidney tumor surgery, only 9% of procedures were a partial nephrectomy. Dr. Russo stated that in recent years, a patient having a partial nephrectomy was more likely to be treated at a major teaching center, with high nephrectomy volumes (>28/yr).

Why is this important? Patients with renal insufficiency, GFR < 60 are at an increased risk: AODM, hypertension, and cardio-vascular disease. Dr. Russo noted that 11% of apparently well individuals already have significant chronic kidney disease (CKD) and in the face of RCC, this figure rises to 25%. Analyzing the likelihood of inducing a significant reduction of GFR, Dr. Russo's data revealed the following:

3-Year Probability of freedom from GFR < 60 PartialNx=80% Radical Nx=35% P-Value <0.001 3-Year Probability of freedom fromGFR < 45 PartialNx=95% Radical Nx=64% P-Value <0.001

Dr. Russo concluded that PN provides equivalent local tumor control to RN for tumors of 7 cm or less, RN is an independent risk factor for the development of CKD, RN is associated with increased post operative cardiovascular events and worse overall survival and that PN is underutilized in the USA and abroad. His final conclusion was that among Urologists worldwide, increased training in PN(open and laparoscopic) is indicated.

Reported by Mitchell C. Benson, MD, a Contributing Editor with UroToday.

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