Less radical surgery for kidney cancer is equally effective to radical alternativve and less likely to cause failure to other kidney

December 13, 2000

A Mayo Clinic study has found that a less radical surgical procedure that removes only the tumor for treatment of kidney cancer results in equivalent long-term survival when compared to its more radical alternative, removal of the entire kidney, and is less likely to result in renal failure in the second kidney.

The study, which appears in the December edition of Mayo Clinic Proceedings, compared the outcomes of 164 patients whose entire kidney was removed during a procedure called radical nephrectomy to 164 patients who underwent nephron-sparing surgery for kidney cancer between 1966 and 1999 at Mayo Clinic. At the time of their first diagnosis, all of these patients with normal kidney function had cancer in one kidney and their second kidney was cancer-free.

"We found that patients who underwent radical nephrectomy had a significantly higher risk of developing kidney failure in their remaining kidney," says Horst Zincke, M.D., a Mayo Clinic urologist and the study's principal investigator. "We also found that long-term survival of patients between the two types of procedures was entirely identical."

At last follow-up, 126 patients (or 77 percent) who underwent radical nephrectomy and 130 patients (79 percent) who underwent the nephron-sparing surgery were alive with no evidence of the disease. At10 years, the cumulative incidence of chronic renal failure was 22 percent for patients who had undergone radical nephrectomy which was twice as high when compared to the 11 percent of patients who underwent the less radical nephron-sparing procedure and experienced renal failure.

"Patients whose kidneys fail experience a significant decrease in quality of life," says Dr. Zincke. "Treating kidney failure also places a financial burden on these patients and society."

During a nephron-sparing procedure, surgeons remove the tumor and spare the surrounding kidney and preserve kidney function. The more radical procedure was first performed in the 1960's and has been the standard for care for patients with cancer in one kidney and a second cancer-free kidney. In recent years, the nephron-sparing procedure has gained acceptance and become more widely used. About 31,000 cases of kidney cancer are diagnosed each year in the United States.

Mayo Clinic physicians also found that when the kidney tumor was less than 4 cm. in diameter, the tumor actually turned out to be benign in 22 percent of all cases.

"Better diagnostic imaging techniques have improved our ability to identify these tumors," says Dr. Zincke. "In some cases, however, those tumors can be benign and removal of the entire kidney is unnecessary."

Mayo Clinic Proceedings is a peer-reviewed and indexed general/internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 120,000 nationally and internationally.
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Chris Gade
507-284-2430 (days)
507-284-2511 (evenings)
e-mail: newsbureau@mayo.edu

Mayo Clinic

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