Editorial Comment

Abstract

In recent years, several important factors have been clarified that favor partial nephrectomy whenever possible for T1a (<4 cm) renal tumors. Approximately 20% of resected small renal masses are benign tumors (ie, renal oncocytoma, fat-poor angiomyolipoma), 25% are indolent tumors with limited metastatic potential (papillary renal cancer type 1, chromophobe carcinoma), and 54% are the more potentially aggressive conventional clear cell carcinoma. Oncological outcomes are equivalent irrespective of whether partial or radical nephrectomy is performed. 1 Russo P. Huang W. The Medical and Oncological Rationale for Partial Nephrectomy for Treatment of T1 Renal Cortical Tumors. Urol Clin North Am. 2008; 35: 635-643 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar Emerging evidence suggests that radical nephrectomy can induce or worsen pre-existing chronic kidney disease and lead to more cardiovascular events and worse overall survival. 2 Huang W.C. Levey A.S. Serio A. et al. Chronic kidney disease following nephrectomy for small renal cortical tumors. Lancet Oncol. 2006; 7: 735-740 Abstract Full Text Full Text PDF PubMed Scopus (1311) Google Scholar , 3 Huang W. Elkin E. Jang T. et al. Partial nephrectomy vs. radical nephrectomy in patients with small renal tumors: is there a difference in mortality and cardiovascular outcomes?. J Urol. 2009; 181: 55-62 Abstract Full Text Full Text PDF PubMed Scopus (688) Google Scholar Single-institution studies have reported similar oncological efficacy for partial nephrectomy for T1b (4-7 cm) tumors 4 Dash A. Vickers A.J. Bach A.M. et al. Comparison of outcomes in elective partial versus radical nephrectomy for clear cell renal cell carcinoma 4-7 cm in size. BJU Int. 2006; 97: 939-945 Crossref PubMed Scopus (193) Google Scholar , 5 Leibovich B.C. Blute M.L. Cheville J.C. et al. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004; 174: 1066 Abstract Full Text Full Text PDF Scopus (493) Google Scholar and similar benefits of renal preservation. Patients particularly sensitive to the adverse effects of radical nephrectomy include the comorbidly ill patients with common medical illness that can affect the kidney (diabetes, hypertension, vascular disease) and in whom eGFR is reduced. 6 Pettus J. Jang T. Thompson H.R. et al. Effect of baseline glomerular filtration rate on survival in patients undergoing partial or radical nephrectomy for renal cortical tumors. Mayo Clin Proc. 2008; 83: 1101-1106 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar Nephron-sparing Surgery Is Equally Effective to Radical Nephrectomy for T1BN0M0 Renal Cell Carcinoma: A Population-based AssessmentUrologyVol. 75Issue 2PreviewTo test the effect of nephron-sparing surgery (NSS) vs radical nephrectomy (RN) on cancer-specific mortality (CSM) in patients with T1bN0M0 renal cell carcinoma (RCC) in a population-based cohort. To date, only few series from tertiary care centers supported the use of NSS for T1bN0M0 (range 4-7 cm) RCC. Full-Text PDF ReplyUrologyVol. 75Issue 2PreviewX et al provide a very eloquent summary of the status of partial nephrectomy for T1bN0M0 lesions. Increasing evidence from centers of excellence, as well as from the current study that is based on a population registry, validates partial nephrectomy as an equally effective treatment modality compared with radical nephrectomy that may result in fewer adverse events. Longer follow-up, well in excess of the current study, will likely provide more solid data regarding long-term detriments of radical nephrectomy and will also probably further reinforce the benefits of partial nephrectomy. Full-Text PDF