Partial nephrectomy versus radical nephrectomy for kidney cancer

Is it necessary to remove the entire kidney if it contains a cancer?

Nephron-sparing surgery, a partial nephrectomy, is recommended for small lesions (tumours ≤4 cm; stage cT1a), provided the resection is technically feasible without compromising complete excision of the cancer. The preference for partial nephrectomy in patients with small renal cell carcinomas is predominantly based on a single prospective randomised controlled trial done by the European Organization for Research and Treatment of Cancer (EORTC). The EORTC study revealed a comparable cancer-specific survival for partial nephrectomy when compared with radical nephrectomy to remove the entire kidney. However partial nephrectomy, by sparing nephrons, leads to superior renal function. Unfortunately, this trial was underpowered and closed prematurely. Other studies suggest that improved renal function following partial nephrectomy leads to a lower risk of cardiovascular complications and mortality from any cause when compared with radical nephrectomy. This evidence resulted in guidelines recommending partial nephrectomy as the treatment of choice for small renal cell carcinomas (cT1a). However, the evidence for larger cT1b tumours (>7cm) is not clear and potential need to be balanced with higher complication rates from surgery. This priority clinical question of partial versus radical nephrectomy for cT1b tumours will be addressed in the forthcoming PARTIAL trial led by Prof Heer and co-chief investigator Prof Soomro. The outcomes evaluated in this trial will include complications, renal function, quality of life, and cost-effectiveness.

https://w3.abdn.ac.uk/hsru/PARTIAL/Public/Public/index.cshtml
https://www.isrctn.com/ISRCTN11293415