World Journal of Urology

, Volume 32, Issue 3, pp 573–579

Do we know (or just believe) that partial nephrectomy leads to better survival than radical nephrectomy for renal cancer?

  • Conrad M. Tobert
  • Christopher B. Riedinger
  • Brian R. Lane
Topic Paper

Abstract

Purpose

Partial nephrectomy (PN) has become the gold standard for treating small renal masses amenable to such an approach. Surprisingly, the single randomized controlled trial of PN versus radical nephrectomy (RN) indicated an overall survival benefit for RN over PN. Recent studies have shed light on this discordance, and this review will attempt to discern what is known at present.

Results

Multiple retrospective observational studies have demonstrated superior outcomes with PN compared with RN. Whether the observed survival benefit with PN is the result of renal functional advantages or the result of selection bias and other unmeasured variables is up for discussion. A meta-analysis of 21 studies including the EORTC 30904 found a 19 % reduction in all-cause mortality (p = 0.0001) and 29 % reduction in cancer-specific mortality (p = 0.0002) with PN versus RN. Recent analysis of SEER-Medicare data revealed that patients undergoing RN had similar survival when compared with non-cancer controls, further supporting concerns about selection biases in prior observational series.

Discussion

Although PN is clearly of benefit for those likely to experience end-stage renal disease with RN, a survival benefit with PN in the elective setting is not proven at present. While experts may still believe PN to improve survival for these patients, the only level I evidence in the field would suggest otherwise, and selection bias is undoubtedly responsible for a significant part of the improved survival observed in retrospective studies. Given recent evidence, any further push to limit the role of RN should be tempered until we know PN is indeed superior.

Keywords

Kidney neoplasms Nephrectomy MIS Nephrometry Renal cell carcinoma 

Abbreviations

PN

Partial nephrectomy

RN

Radical nephrectomy

GFR

Glomerular filtration rate

CKD

Chronic kidney disease

RCT

Randomized controlled trial

RCC

Renal cell carcinoma

SRM

Small renal masses

OS

Overall survival

ACM

All-cause mortality

CSM

Cancer-specific mortality

HR

Hazardous ratio

ESRD

End-stage renal disease

CAD

Coronary artery disease

RFD

Renal functional decline

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Conrad M. Tobert
    • 1
    • 2
  • Christopher B. Riedinger
    • 1
    • 2
  • Brian R. Lane
    • 1
    • 2
    • 3
  1. 1.Michigan State University College of Human MedicineGrand RapidsUSA
  2. 2.Spectrum Health Hospital SystemGrand RapidsUSA
  3. 3.Urology DivisionSpectrum Health Medical GroupGrand RapidsUSA

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