Laparoscopic radical nephrectomy more popular than open partial resection

NEW YORK (Reuters Health) - Increasing use of laparoscopic radical nephrectomy appears to be linked with decreasing use of partial nephrectomy, Canadian researchers report in the February issue of the Journal of Urology.

Partial nephrectomy and radical nephrectomy are equivalent for cancer control, but partial resection offers "the added benefits of saving the majority of the kidney by only excising the tumor-bearing tissue," senior author Dr. Antonio Finelli, from the University of Toronto, told Reuters Health.

He added, "We know that kidney function is associated with cardiovascular morbidity and overall well being -- and survival. Thus, renal preservation is paramount."

But when Dr. Finelli and his associates studied data on more than 7800 Canadian patients who had surgery for renal cell carcinoma between 1995 and 2004, they found that 89.8% had radical nephrectomies and only 10.1% had partial resections.

Furthermore, rates of partial nephrectomies had been rising by 18% per year - until 2003. After that, use of the partial resection decreased by 12% per year.

Overall, patient age and the year of surgery were independent predictors of partial nephrectomy. The kidney-sparing approach was used in 13.2% of patients less than 50 years old versus 4.9% of those aged 80 years old or more.

"Lastly," Dr. Finelli concluded, "although there are disincentives to performing open partial nephrectomy -- technically challenging, slightly increased potential for complications, and less remuneration -- we do not know which if any and to what degree they impacted on decision making."

"We can only hypothesize that the relationship (between the methods) was causal," he added. "Also, we could not account for patient preference."

Copyright © 2010 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.