Kidney removal fails to improve survival of older patients with kidney cancer

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Older patients with localized kidney cancer do not benefit from kidney removal, according to a study published in Cancer (2010 May 10 [Epub ahead of print]).

Steve Campbell, MD, PhD, of the Cleveland Clinic, and colleagues conducted a study to examine whether surgical kidney removal improved survival better than active monitoring. Investigators studied data on 537 patients with localized kidney tumors that were ≤ 7cm in diameter and were detected in patients 75 years or older. Of the study cohort, 20% were closely monitored, 53% had kidney-sparing surgery, and 27% underwent surgical kidney removal.

Investigators reported that after an average follow-up of approximately 4 years, 28% of patients died. Cancer progression was responsible for only 4% of deaths, and older age and additional medical conditions resulted in an increase of risk of patients dying.

The study also revealed that patients who had a cancerous kidney removed experienced dysfunction of their remaining kidney at a faster rate compared to those who did not. Surgical kidney removal was also linked to an increased risk of dying from cardiovascular causes.

“Current research is indicating over-treatment of localized renal tumors, and our data suggest that active surveillance is a reasonable strategy and one that is greatly underutilized in the elderly population,” the authors wrote. “The potential benefits of kidney-sparing surgery in elderly patients who have the lowest risk for heart-related deaths and the greatest life expectancy warrant further investigation.”

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