Partial Nephrectomy Is An Option for Larger Tumors

Partial nephrectomy (PN) can be safely performed in patients with renal tumors 7 cm or more in diameter with acceptable technical, oncologic and functional outcomes, according to researchers.

Consequently, they concluded, PN should be a surgical option when feasible regardless of tumor size. Christopher J. Long, MD, of Fox Chase Cancer Center in Philadelphia, and colleagues used a prospectively maintained institutional kidney cancer database to identify 46 patients undergoing PN for 49 renal tumors 7 cm or more in diameter. The patient population included 33 men and 13 women.

The patients had a median age of 58 years (range 21-83) and a median tumor size of 8.7 cm. Thirteen patients (25.5%) had 7.0-7.9 cm tumors, 11 (22.5%) had 8.0-8.9 cm tumors, and five (10.2%) had 9.0-9.9 cm tumors.

Twenty patients (40.8%) had tumors larger than 10 cm. Approximately 80% of tumors were malignant. The five- and 10-year overall and renal cell carcinoma-specific survivals were 94.5% and 70.9%, respectively, the researchers reported in BJU International (2012;109:1450-1456). The five- and 10-year recurrence-free survival rates were 88.7% and 66.5%, respectively. Five patients (10.9%) had an upward migration in their chronic kidney disease status after PN. Sixteen complications occurred after a median follow-up of 13.1 months (range 0.2–170.0 months), including four (8.2%) blood transfusions and six (12.2%) urinary fistulae.

The researchers noted that their results compare favorably with those of published reports of similarly stage matched tumors treated with radical nephrectomy.
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