Partial nephrectomy for T1-2 kidney cancers is safe and effective compared to radical nephrectomy, however subtle differences do exist between the two treatments, in this randomized EORTC phase 3 study
In this rare randomized study 541 men with T1-T2 localised kidney tumors underwent either partial nephrectomy (PN) or radical nephrectomy (RN) and followed for 9 years. Unexpectedly, the overall survival (OS) rates were slightly better for RN 81% v 75.7%, and the main cause of death in both groups was cardiovascular death. However when only the kidney cancer subset (that is excluding those patients who did not have kidney cancer) was analysed this overall survival difference was a trend and did not reach statistical significance. The rate of cancer progression at 10 year was 4.1% in PN and 3.3% in RN. There were only 12 kidney cancer deaths over the 10 year period, 4 in RN and 8 in PN. The median postoperative creatinine was 1.3 mg/dl in PN and 1.5 mg/dl in RN. The risk of perioperative bleeding is higher in the PN group (30% v 16% RN). The key results therefore are:
- Both techniques provide secure cancer outcomes at 10 years
- PN has better blood kidney function tests at 10 years
- Cardiovascular death was the leading cause of death in both groups at 10 years, at about the same rate in both groups (7.3% RN v 9.3% PN)
- The overall survival differences are hard to explain
- PN is safe and effective with warm ischemic times under 30-40 minutes
- Laparoscopic radical nephrectomy is the method of choice for RN.