NSS Suitable for Larger Tumors, Regardless of Age
Nephron-sparing surgery (NSS), the gold-standard treatment for renal tumors 4 cm or less in diameter, appears to benefit long-term kidney function in cases involving larger tumors as well—even in elderly patients, according to findings published in BJU International (2011;107:554-561).
In a recent comparison of NSS and radical nephrectomy (RN) for renal tumors larger than 4 cm in diameter, 36 subjects younger than age 55 years underwent NSS and 45 underwent RN. Among persons older than age 65 years, 33 had NSS and 52 had RN.
The median tumor size was 6 cm in the younger group and 5 cm for the elderly participants. Complication rates did not differ between the age groups or between NSS and RN in young or elderly patients. Overall survival did not significantly differ between NSS and RN in the young or elderly groups.
However, among the younger patients, chronic kidney disease (CKD) occurred in 31.1% of RN patients and only 15.5% of NSS patients over a median follow-up of 5.69 years. Among elderly patients, CKD occurred in 50.9% of the RN patients compared with only 4.2% of NSS patients over a median follow-up of 5.48 years.