Total nephrectomy overused in kidney cancer

Although partial nephrectomy may be appropriate for dealing with small renal masses, total nephrectomy appears to be the more usual surgical modality in the majority of such cancer patients, researchers report in the March issue of the Journal of Urology.

“Using available population-based data, the proportion of patients undergoing partial nephrectomy is surprisingly low,” senior investigator Dr. Brent K. Hollenbeck told Reuters Health. “Among those with tumors between 2 and 4 cm, the proportion of patients undergoing of partial nephrectomy was only approximately 20%.”Dr. Hollenbeck and colleagues at the University of Michigan, Ann Arbor, studied data from 1998 to 2001 on more than 14,600 patients who underwent surgery for locoregional kidney cancer with a primary tumor size of 7 cm or less.The proportion of patients undergoing partial nephrectomy rose from 4.6% at the start of the studied period to 17.6% at the end.”Despite evidence supporting the equivalent oncologic efficacy and longer-term quality-of-life benefits of partial nephrectomy,” continued Dr. Hollenbeck, “the majority of patients with small renal tumors appear to be undergoing total nephrectomy.”Possible reasons for this, he added, “include patient preference, comorbidities and other possible contraindications, or physician preference.”Future work, he concluded, “will detail whether this trend continues and the source of the observed low utilization rates.”(Source: J Urol 2006;175:853-858: Reuters Health: Oncolink: February 2006.)