Nonsurgical treatment of small tumor renal cancer may be as effective as radical nephrectomy but with fewer complications

1. Rates of renal insufficiency were highest in patients receiving renal nephrectomy, compared to less invasive treatments.

2. Survival rates for renal nephrectomy and partial nephrectomy were very similar, suggesting little difference in efficacy between these treatments.

Evidence Rating Level: 2 (Good)

Study Rundown: Renal stage carcinoma (RCC) has relatively low mortality rates with respect to cancer diagnoses, as the disease tends to be slow growing. Most of these tumours are found incidentally and are classified as stage T1. Treatment options for stage T1a RCC include radical nephrectomy, as well as partial nephrectomy. In this case, radical nephrectomy is currently the most used treatment, despite its risk of renal insufficiency. The authors of this study therefore aimed to compare outcomes of treatment options for stage T1a RCC (partial ablation, partial nephrectomy, renal nephrectomy). Generally, it was observed that nonsurgical treatments may be equally as effective as radical nephrectomy, but with fewer complications. This study had several limitation. Of note, since there was a lack of data in patients under the age of 66 years old. As a result, this study may not be applicable to a younger cohort of patients. Further, the authors were unable to include procedures after 2011 based on the restrictions of the methodology.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Treatment of renal cell carcinoma: Current status and future directions

In-Depth [retrospective cohort]: In this observational cohort study, the authors included a total of 4310 patients, ho were followed by a median of 52 months for overall survival and 42 months for RCC-specific survival. These patients were obtained from the population-based SEER cancer registry data linked to Medicare claims. Outcomes included RCC-specific and overall survival, 30- and 365-day post intervention complications. Regarding adverse events, the total rates of renal insufficiency fro m31 to 365 days after partial ablation, partial nephrectomy, and renal nephrectomy were 11% (CI, 8% to 14%), 9% (CI, 8% to 10%), and 18% (CI, 17% to 20%), respectively). Further, survival rates were highly similar between the treatment options, ranging from 95% to 98%.

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