Nephron-sparing surgery offers better long-term kidney function

Patients with kidney tumors larger than 4 cm are much more likely to enjoy good long-term renal function if they undergo nephron-sparing surgery rather than radical nephrectomy, say German researchers.

For their study, which was published in BJU International (2011; 107:554-61), urologists at Johannes Gutenberg University in Mainz, Germany, studied 166 patients for up to 19 years, with a median follow-up of 5.5 years. The patients were split into two groups-81 "younger" patients up to 55 years of age and 85 "older" patients aged 65 years and over.

Researchers found that, regardless of age, the patients who underwent radical nephrectomy were twice as likely to develop new onsets of chronic kidney disease than those who underwent nephron-sparing surgery.

"Overall survival and complication rates were similar between the two groups, but long-term kidney function, which is very important to overall health and quality of life, was much better in the patients who had received nephron-sparing surgery," said lead author Frederik C. Roos, MD. "Our results show that 76% of older patients enjoyed good long-term kidney health with nephron-sparing surgery as did 85% of younger patients."

Additional findings included:

• The incidence of chronic kidney disease in patients aged 23 to 55 years was 31% after radical nephrectomy and 16% after nephron-sparing surgery. In patients aged 65 to 84 years, it was 51% and 24%, respectively.
• Overall survival rates did not differ significantly between surgical procedures.
• Complication rates were similar for both procedures, occurring in 35% of younger patients and 26% of older patients.