Is partial nephrectomy oncologically safe for tumors greater than 4cm?

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Mar 7 2006

Traditionally, nephron sparing surgery in the presence of a normal contralateral kidney is primarily advocated for tumors <= 4cm.

More recently, investigators have challenged that dogma and demonstrated oncologic equipoise for partial nephrectomy (PN) in larger, anatomically receptive tumors. Here, the group from Columbia reports on their series of partial nephrectomies (PN’s) for tumors greater than 4 cm in diameter.

Thirty-three patients underwent PN over a 16 year period for tumors => 4cm. These patients were compared to a contemporary group undergoing radical nephrectomy (RN), matched by tumor size. The complication rate in the PN group was 15.2% versus 12.1% in the RN group. The authors noted that the 5 year recurrence free survival was 93.5% for the PN group, which was not significantly different from the 83.3% noted for the RN group (p=0.471). Five year disease specific survival was 96.2% for the PN group, and 97.8% for the RN group (p=0.893). In a multivariate analysis, surgical technique did not have an impact on recurrence free survival (p=0.661). Only tumor diameter predicted recurrence in this series (p=0.008), regardless of how the tumor was removed.

While retrospective and therefore with inherent bias, this study provides further evidence that partial nephrectomy can be safely performed even on tumors larger than 4 cm when anatomically receptive.

The real question that remains unanswered sufficiently to date is whether or not patients that undergo partial nephrectomy for these larger tumors derive some tangible benefit from the additional retained renal tissue.

By Christopher G. Wood, MD

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