Partial nephrectomy superior in survival, costs

March 18, 2013

In patients with small renal masses, partial nephrectomy results in better overall survival and lower costs compared with radical nephrectomy, say researchers from Medstar Georgetown University Hospital, Washington.

In patients with small renal masses, partial nephrectomy results in better overall survival and lower costs compared with radical nephrectomy, say researchers from Medstar Georgetown  University Hospital, Washington.

Using Surveillance, Epidemiology, and End Results-Medicare data, the study authors identified 1,682 patients who had been diagnosed with small renal masses between 2005 and 2007. The authors then compared effectiveness, costs, and trends in the treatment of these patients. Patients were treated with open radical nephrectomy, minimally invasive radical nephrectomy, open partial nephrectomy, minimally invasive partial nephrectomy, ablation, and surveillance.

The authors found that minimally invasive approaches had shorter lengths of stay (p<.001), while open approaches led to more overall complications, respiratory complications, and intensive care unit admissions (all p<.003), researchers reported. Ablation, minimally invasive radical nephrectomy, and open radical nephrectomy were associated with the highest overall mortality rates (p<.001), and minimally invasive and open radical surgery were associated with the highest cancer-specific mortality rates (p<.001).

"This study reinforces on a greater scale that leaving the healthy part of the kidney benefits the patient in terms of cancer survival, overall survival, costs, and fewer postoperative complications. Additionally, doing the partial removal via a minimally invasive approach, when possible, leads to quicker recovery," said first author Keith Kowalczyk, MD.

Dr. Kowalczyk noted that adoption of partial nephrectomy can lower costs. Treatment costs were lowest for surveillance ($2,911), followed by ablation ($10,730), minimally invasive radical nephrectomy ($15,373), minimally invasive partial nephrectomy ($15,695), open partial nephrectomy ($16,986), and open radical nephrectomy ($17,803).

"Doing partial nephrectomy will absolutely decrease health care costs because there are going to be fewer patients with renal inefficiency or kidney failure afterwards. Additionally, minimally invasive surgery also leads to a shorter hospital stay and faster return to normal activities. That means fewer patients with overall problems and costly complications," Dr. Kowalczyk said.

Study results were published online in BJU International (March 4, 2013).

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