Localized kidney cancer: Changing patterns of care

July 1, 2008

Open radical nephrectomy has long been the standard of care for patinets with organ-confined or locally advanced renal cell carcinoma. In recent years, however, laparoscopy has replaced open surgery for some patients undergoing radical nephrectomy, based on easier convalescence with equivalent cancer control.q

At the same time that laparoscopic radical nephrectomy was being introduced, studies demonstrated that for patients with small renal masses, partial rather than radical nephrectomy achieves equal cancer control while better preserving long-term renal function and reducing over-treatment of benign or clinically indolent tumors (J Urol 2000; 163:442-5; J Urol 1999; 162:1930-3; Urology 2002; 59:816-20; Lancet Oncol 2006; 7:735-40; Cancer 2008; 112:511-20).

Laparoscopic radical nephrectomy is now accepted as an alternative standard of care for many patients with renal tumors that merit extirpative surgery (Clin Cancer Res 2004; 10 [18 Pt 2]:6322S-7S; J Urol 2005; 173:547-51). Within the last decade, several institutions have published case series documenting sequential annual increases in the proportion of renal masses excised with laparoscopic techniques (BJU Int 2006; 98:751-5). At the University of Michigan, for instance, the use of a laparoscopic surgical approach for treatment of patients with organ-confined renal cell carcinoma increased significantly: 43% of all cases between 1998 and 2000 and 55% of all cases between 2001 and 2003 (Urology 2006: 67:1175-80).

Illustrating this point, data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) were used to calculate annual incidence rates for open and laparoscopic surgery for renal cell carcinoma among more than 50,000 patients treated between 1991 and 2003 (J Urol 2006; 176:1102-6). During this interval, the incidence of both laparoscopic and open renal cancer surgery increased significantly (figure 1). Despite this trend, laparoscopy nonetheless remains a relatively uncommon technique for surgical management of renal malignancies.