Partial Nephrectomy Versus Radical Nephrectomy in Patients With Small Renal Tumors-Is There a Difference in Mortality and Cardiovascular Outcomes? Journal Article

   

Authors:	Huang, W. C.; Elkin, E. B.; Levey, A. S.; Jang, T. L.; Russo, P.
Article Title:	Partial Nephrectomy Versus Radical Nephrectomy in Patients With Small Renal Tumors-Is There a Difference in Mortality and Cardiovascular Outcomes?
Abstract:	Purpose: Compared with partial nephrectomy, radical nephrectomy increases the risk of chronic kidney disease, which is a significant risk factor for cardiovascular events and death. Given equivalent oncological efficacy in patients with small renal tumors, radical nephrectomy may result in overtreatment. We analyzed a population based cohort of patients to determine whether radical nephrectomy is associated with an increase in cardiovascular events and mortality compared with partial nephrectomy. Materials and Methods: Using Surveillance, Epidemiology and End Results cancer registry data linked with Medicare claims we identified 2,991 patients older than 66 years who were treated with radical or partial nephrectomy for renal tumors 4 cm or less between 1995 and 2002. The primary end points of cardiovascular events and overall survival were assessed using Kaplan-Meier survival estimation, Cox proportional hazards regression and negative binomial regression. Results: A total of 2,547 patients (81%) underwent radical nephrectomy and 556 (19%) underwent partial nephrectomy. During a median followup of 4 years 609 patients experienced a cardiovascular event and 892 died. When adjusting for preoperative demographic and comorbid variables, radical nephrectomy was associated with an increased risk of overall mortality (HR 1.38, p <0.01) and a 1.4 times greater number of cardiovascular events after surgery (p <0.05). However, radical nephrectomy was not significantly associated with time to first cardiovascular event (HR 1.21, p = 0.10) or with cardiovascular death (HR 0.95, p = 0.84). Conclusions: Radical nephrectomy, which is currently the most common treatment for small renal tumors, may be associated with significant, adverse treatment effects compared with partial nephrectomy. Partial nephrectomy should be considered in most patients with small renal tumors. © 2009 American Urological Association.
Keywords:	controlled study; aged; aged, 80 and over; surgical technique; major clinical study; mortality; disease free survival; outcome assessment; follow up; disease association; tumor volume; kidney neoplasms; nephrectomy; cancer mortality; postoperative complications; kidney; partial nephrectomy; radical nephrectomy; kidney tumor; cardiovascular disease; cardiovascular diseases; comorbidity; intermethod comparison; organ size
Journal Title:	Journal of Urology
Volume:	181
Issue:	1
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2009-01-01
Start Page:	55
End Page:	62
Language:	English
DOI:	10.1016/j.juro.2008.09.017
PUBMED:	19012918
PROVIDER:	scopus
PMCID:	PMC2748741
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-57149120089&partnerID=40&md5=87038824d1f244553d069f67a63f6d2c
Notes:	--- - "Cited By (since 1996): 63" - "Export Date: 30 November 2010" - "CODEN: JOURA" - "Source: Scopus"

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