Nephron-sparing surgery preserves kidney function in large tumors, too

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Nephron-sparing surgery has become the gold standard of treatment in renal tumors that measure no more than 4 cm, and it now appears to benefit long-term kidney function in cases involving larger tumors as well—even in elderly patients.

A recent study compared the functional outcomes of persons undergoing nephron-sparing surgery (NSS) or radical nephrectomy (RN) for renal tumors larger than 4 cm. In the group of subjects younger than 55 years, 36 underwent NSS and 45 underwent RN. Among elderly patients—those older than 65 years—33 underwent NSS and 52 underwent RN. Median tumor size was 6 cm in the younger group and 5 cm in the elderly participants.

Complication rates did not differ between the age groups, or between NSS and RN in young or elderly patients. Overall survival did not significantly differ between NSS and RN in the young or elderly groups. However, chronic kidney disease occurred in 31.1% of the young RN patients but just 15.5% of the young NSS patients over a median follow-up of 5.69 years, and in 50.9% of the elderly RN patients but 24.2% of the elderly NSS patients over a median follow-up of 5.48 years.

“Our results show that 76% of older patients enjoyed good long-term kidney health with NSS, as did 85% of younger patients,” noted lead researcher Dr. Frederik C. Roos, a urologist at Johannes Gutenberg University in Mainz, Germany, upon publication of his team's study in BJUI (2011;107[4]:554-561).

Dr. Roos also pointed out that kidney tumors are more common in persons in their 60s and 70s, and that increasing life expectancy means that more elderly patients will seek treatment for this condition.

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