Nephron-sparing surgery (NSS) for small renal masses substantially decreases the incidence of moderate renal dysfunction compared with radical nephrectomy (RN), according to the results of the prospective European Organization for Research and Treatment of Cancer (EORTC) randomized trial.
The beneficial impact of NSS on renal function, as assessed by estimated glomerular filtration rate (eGFR), did not result in improved survival, however.
In the study, investigators randomized 273 patients to undergo RN and 268 to undergo NSS for renal masses 5 cm or less in size. After a median follow-up of 6.7 years, moderate renal dysfunction (eGFR below 60 mL/min/1.73 m2) developed in 85.7% of the RN patients compared with 64.7% of the NSS patients. The incidence of advanced kidney disease (eGFR below 30) was similar in the two treatment arms (10% and 6.3%); the incidence of kidney failure (eGFR below 15) was nearly identical (1.5% and 1.6%), Emil Scosyrev, PhD, and colleagues at the University of Rochester Medical Center in Rochester, N.Y., reported online ahead of print in European Urology.
The researchers acknowledged that lack of longer follow-up for eGFR was a study limitation.
The EORTC trial previously had demonstrated that NSS was associated with a significant 50% increased overall mortality risk compared with RN over a median follow-up of 9.3 years. When the analyses were limited to patients with renal cell carcinoma, researchers found no significant difference in overall survival.