Radical nephrectomy may be risk factor for kidney disease

Kidney cancer patients with two otherwise healthy kidneys who underwent partial nephrectomy to remove a small cancer developed chronic kidney disease at a rate one-third lower than patients who underwent radical nephrectomy, reported researchers from Memorial Sloan-Kettering Cancer Center in New York.

The 3-year probability of staying free of chronic kidney disease was 80% for the partial nephrectomy patients compared with 35% for radical nephrectomy patients. In fact, radical surgery was shown to be a significant risk factor for developing chronic kidney disease (Lancet Oncol 2006; 7:735-40).

The retrospective study of 662 patients showed that up to 26% of the patients had pre-existing chronic kidney disease before undergoing surgery to remove a small renal tumor (less than 4 cm). In addition, those patients who had the entire kidney removed were more than twice as likely to develop chronic kidney disease.

“Evidence has accumulated from our Center and elsewhere that partial nephrectomy provides effective local tumor control and equivalent survival rates to that of radical nephrectomy for small tumors,” said senior author Paul Russo, MD. “However, while approximately 70% of kidney tumor operations at MSKCC are partial nephrectomies, national databases from the United States and abroad suggest that greater than 80% of patients may be unnecessarily undergoing the more radical surgery to remove the entire kidney, even for small renal tumors.

“One explanation may be that partial nephrectomy is a more complex surgical procedure.”