Partial Nephrectomy Preferred over Radical Procedure for Small Renal Masses

June 2011, Vol 2, No 3 -

Reduced cost, improved clinical outcomes

Orlando, FL—Guidelines for the management of stage I renal masses include partial and radical nephrectomy, but results of a new study presented at the 2011 Genitourinary Cancers Symposium suggest that partial nephrectomy is less costly and leads to fewer adverse health outcomes associated with kidney disease.

“Partial nephrectomy is cheaper and has better health outcomes; therefore, it is a better choice,” said Steven L. Chang, MD, MS, urology surgeon at Brigham and Women’s Hospital and instructor at Harvard Medical School.

Dr Chang and colleagues quantified, in general, the long-termeconomic and clinical costs of postoperative chronic kidney disease (CKD) after radical and partial nephrectomy, using a Markov model. The researchers based the findings on a 65-year-old man with normal renal function before treatment. They then evaluated cost, quality of life, and transition probabilities based on published literature, Medicare data, and expert opinions.

The associated costs over the patient’s lifetime were approximately $200,000 for radical nephrectomy compared with approximately $150,000 for partial nephrectomy. Patients receiving the partial surgery also would experience a better quality of life.

“Chronic kidney disease, stage 3, 4, and 5, has a 2-fold higher medical cost,” Dr Chang said. “With comorbidities, the cost gets multiplied.”

Dr Chang added that in many instances, physicians may not see the outcome of kidney disease, because it may occur after they stop following the patient, as many as 5 or 10 years after the initial surgery. He advised physicians to discuss with patients the long-term consequences before proceeding with surgery.

Over a lifetime, the research team found little cost difference between open and laparoscopic approaches. However, CKD led to a substantial cost increase and a decrease in health outcomes, regardless of the surgical method.

The impact is higher on younger patients,” Dr Chang said. “In a 45-year-old male, physicians should think twice before doing a radical nephrectomy. The chance of a major impact is higher than with an 85-year-old.”

Even in those cases where surgeons perform a partial nephrectomy, patients still often experience issues associated with kidney disease, Dr Chang said. He suggested performing a percutaneous biopsy to verify the lesion is malignant before proceeding with either a partial or radical nephrectomy, because new-onset postoperative CKD has a substantial economic and clinical affect on long-term outcomes.

“If at all possible, physicians should do a partial nephrectomy,” Dr Chang said. “It’s cheaper and has better health outcomes. It’s a better choice.”