Partial Nephrectomy Offers Better Renal Preservation, Survival

Partial nephrectomy (PN) may confer a clinical benefit in terms of improved renal function and overall survival compared with radical nephrectomy (RN) after excluding the confounding effect of malignancy, according to a new study.

Using the Mayo Clinic Nephrectomy Registry, Dharam Kaushik, MBBS, of the Mayo Clinic in Rochester, Minn., and colleagues retrospectively identified 442 patients with unilateral sporadic benign renal masses treated surgically with RN (206 patients) or PN (236 patients) from 1980 to 2008.

The median follow-up for patients still alive at the last follow-up was 8.3 years. The estimated overall survival rates at 10 and 15 years were 69% and 53%, respectively, for RN compared with 80% and 74%, respectively, following PN. Compared with PN-treated patients, patients who underwent RN were 75% more likely to die from any cause and more than four times more likely to develop stage IV chronic kidney disease, after adjusting for covariates, according to findings published online in European Urology. All of these differences between the RN and PN group were significant.

Patients who underwent RN were significantly older than those who underwent PN (median age 67 vs. 64 years) and had significantly larger tumors (median 5.0 vs. 2.7 cm).

The investigators acknowledged that their study was limited by its retrospective design, selection bias for surgical approach, and referral bias to a tertiary care facility.