Partial nephrectomy is now more frequently used in the U.S. than radical nephrectomy.
A study of the U.S. Surveillance, Epidemiology and End Results (SEER) registry 2001-2009 data shows that surgery continues to be the most common treatment, with nephron-sparing surgery exceeding radical nephrectomy. Dr. william C. Huang, Feinberg School of Medicine, Northwestern University, and his colleagues published their analysis in the July issue of JAMA Surgery.
While nonsurgical management (watchful waiting) is a reasonable treatment strategy for elderly patients or those with limited life expectancy, its use remains low.
It should be noted that this study covers data through 2009, or six years ago. Presentations at the Kidney Cancer Symposium Novemeber 2015 in Miami, Florida, do indicate an increase in non-surgery, or surveillance, especially in cases where the tumor is small and the patient is at high risk for surgical complications. Dr. Daniel Heng showed calculations he has worked out to show the patient’s life expectancy with and without surgery. Usually surgery is beneficial, but in cases where the patient is already over 80, has a number of other health issues, and is not a good risk for surgery, their chance of dying of something other than kidney cancer is often higher, so surgery is less likely to benefit and might even harm the patient.
Non-invasive treatments like cryotherapy or radio frequency ablation are shown in the Huang study to be reserved for people who are not good surgical risks. Laparoscopic and robotic surgeries are more precise and leave less scar tissue behind and are therefore ma
“Our analysis demonstratess that radical nephrectomy is no longer the treatment of choice for small kidney cancers,” said Huang. “Expert guidelines for the management of small renal masses, such as those published by the American Urological Association in 2009, appear to have bolstered the paradigm shift away from radical nephrectomy toward nephron-sparing options for such tumors.”
“Our findings underscore the importance of competing causes of mortality in this population: 38.1% of patients died during the study period, but only 4.4% of patients died from kidney cancer,” says Huang.
Joshua Meeks, in an accompanying editorial, notes that despite an overall increase in surgery for small renal masses (SRMs), the survival for patients with kidney cancer has not changed. “At some point,” he emphasized, “every metastatic cancer must have been an SRM. As we learn more about the molecular signature of renal cancer and the mutations that drive progression, we will likely be managing SRMs differently in the near future.”
Huang, W.C., et al, “Management of small kidney cancers in the new millennium contemporary trends and outcomes in a population-based cohort.” JAMA Surg 2015: DPOO: 10.1001/jamasurg.2015.0294.4
Meeks JJ at al, “Standard of care for small renal masses in the 21st Century” JAMA Surg 2015: DOI: 10.1001/jamasurg.2015.04440
