Renal cancer. Contemporary management. Editor John A. Libertino. Springer New York 2013.
Partial versus radical nephrectomy
Equivalent cancer control between partial nephrectomy and radical nephrectomy has been established for clinical T1-T2 tumors. The added benefits of performing partial nephrectomy include preserved renal parenchyma and less overtreatment of benign renal tumors.
Most studies comparing radical and partial nephrectomy oncologic outcomes are retrospective and therefore have several inherent issues with study validity, most notably selection bias. In a review of Surveillance, Epidemiology and End Results (SEER) cancer registry data, partial nephrectomy was associated with reduced mortality and decreased number of postoperative cardiovascular events compared to radical nephrectomy. Van Poppel and colleagues compared radical and partial nephrectomy in a multicenter, randomized controlled trial of 451 patients with T1-T2 renal tumors. At a median follow-up of 9.3 years, the total number of cancer-related deaths was 12, and 21 patients had disease progression with no significant difference between the two groups. Excluding patients with multifocal disease at the time of surgery, there was no difference in 10-year overall survival between the groups concluding that partial nephrectomy provides a valuable and, in select cases, superior option for the treatment of T1-T2 renal tumors.