Surgery is the most common form of treatment for kidney tumors and often the only treatment necessary to achieve a cure. However, a recent survey led by investigators at Memorial Sloan Kettering and the National Kidney Foundation has found that many patients with small kidney tumors are not told that a kidney-sparing surgery called partial nephrectomy can save their lives while preserving kidney function.
Partial nephrectomy is a procedure in which the surgeon carefully removes only the tumor while preserving the majority of the kidney. In contrast, radical nephrectomy is an operation in which the surgeon removes the entire kidney and its surrounding tissue.
Radical nephrectomy is required for massive kidney tumors that have replaced most of the healthy kidney, but the procedure can increase a patient’s risk of developing chronic kidney disease and subsequent cardiovascular complications.
“Physicians, patients, and caregivers alike need to be better educated about kidney-sparing strategies and the consequences of radical nephrectomy for small kidney tumors,” said Dr. Russo. “This will help patients make the most informed treatment decision for both their cancer and long-term health, and possibly avoid the complications of chronic kidney disease.”
Low Awareness of Treatment Options
Memorial Sloan Kettering kidney surgeon Paul Russo surveyed 365 people with kidney cancer and 52 caregivers about their understanding of kidney-sparing surgical options and the risk factors for chronic kidney disease. Findings from this survey were published online on March 25 in the National Kidney Foundation’s American Journal of Kidney Diseases.
Dr. Russo and his team found that more than a quarter of the patients said they were not told about partial nephrectomy, its benefits, and whether they were a candidate for such an operation. As a result, less than 20 percent of those kidney cancer patients with early-stage kidney tumors underwent a partial nephrectomy, while 80 percent had their entire kidney removed. Patients who underwent radical nephrectomy were also unaware of their risk for developing or worsening chronic kidney disease.
At Memorial Sloan Kettering, more than 90 percent of patients with small kidney tumors are treated with partial nephrectomy. Dr. Russo and his team also promote active surveillance as an approach for small renal tumors in the elderly and patients with other health complications. In these patients, the risks associated with surgical intervention and hospitalization are far greater than the risks of significant tumor progression or spread in their lifetimes.
Better Education Needed
Memorial Sloan Kettering surgeons have been instrumental in pioneering research to define the optimal treatment for kidney tumors. They have found that in nearly half the patients with small kidney tumors, the tumors are indolent or benign, with little or no potential to spread to other parts of the body.
Studies conducted here and at other institutions have demonstrated that in patients with small kidney tumors, partial nephrectomy is as effective as radical nephrectomy at controlling cancer, while preserving kidney function and preventing the complications of chronic kidney disease.
About 70 percent of patients diagnosed with kidney cancer each year have a kidney tumor that is considered small, making those patients candidates for this procedure. And nearly one-third of patients with kidney cancer already have evidence of preexisting chronic kidney disease, which can be made worse by radical nephrectomy.
Dr. Russo and his team perform more than 300 partial nephrectomies per year and have expanded their kidney-sparing surgical program to include larger tumors and those located deep inside the kidney or adjacent to critical blood vessels. Their research data indicates that just as with smaller tumors, partial nephrectomy in these more complicated cases is as effective as radical nephrectomy at controlling cancer, with the added benefit of preserving kidney function.
According to Dr. Russo, “Treatment at a high-volume hospital with a robust multidisciplinary research team is a definite advantage for patients with kidney tumors.”