Partial nephrectomy maintains renal function in cT1a RCC

Dec 17 2012

By Joanna Lyford, Senior medwireNews Reporter

Partial nephrectomy (PN) offers a similar magnitude of benefit in patients with clinical (c) T1b versus cT1a renal cell carcinoma (RCC), Japanese researchers have shown.

PN is the new standard surgical procedure for patients with small renal masses, and has several advantages over radical nephrectomy (RN). However, few studies have evaluated longer-term outcomes of PN in patients with cT1b tumors or compared outcomes with those in patients with cT1a tumors.

To investigate, Tsunenori Kondo (Tokyo Women's Medical University, Shinjuku-ku, Japan) and team retrospectively analyzed data on 586 patients who underwent surgery for RCC at a single center between 1979 and 2011.

In all, 67 patients underwent PN for cT1b tumors, 195 patients underwent RN for cT1b tumors, and 324 underwent PN for cT1a tumors.

Following PN, renal function as indicated by estimated glomerular filtration rate (eGFR) in patients with cT1b and cT1a tumors was 59.5 and 63.8 mL/min per 1.73 m² at 1 year, respectively, 58.5 and 61.9 mL/min per 1.73 m² at 3 years, respectively, and 65.3 and 62.3 mL/min per1.73 m² at 5 years after surgery.

"There was no statistical difference between these two groups," write Kondo et al. "Postoperative residual renal function after PN was steadily maintained after surgery without deterioration."

In the RN group, eGFR in patients with cT1b tumors was 47.1, 49.8 and 51.9 mL/min per 1.73 m² at 1, 3, and 5 years after surgery, respectively.

"RN resulted in significantly decreased eGFR levels compared with those after PN at any time-point during the 5 years after surgery," the researchers state.

In terms of other outcomes, the probability of freedom from new-onset chronic kidney disease after PN for clinical T1b tumors was significantly higher than that after RN for clinical T1b tumors, and similar to that after PN for clinical T1a tumors.

Kondo et al write: "The higher anatomical complexity of clinical T1b tumors is unlikely to provide a significant influence on postoperative renal function after partial nephrectomy, when compared with the clinical T1a tumors.

"These findings support the beneficial role of PN in the preservation of renal function of clinical T1b renal cell carcinoma patients undergoing surgery."

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