Speculation exists as to possible reasons for the lack of embracing partial nephrectomy (PN) as an effective treatment, including lack of training or expertise, perceived oncologic inferiority to radical nephrectomy (RN), and a higher, more devastating complication rate have all been implicated. Nonetheless, there remains a huge body of literature that suggests that PN has equivalent oncologic outcomes to RN, and that preservation of renal mass provides additional benefits, which cannot be discounted. In this study, Van Poppel and colleagues from 40 institutions report on the complications associated with a randomized Phase III EORTC Intergroup multicenter trial comparing RN to PN for low stage renal cell carcinoma (RCC), with comparative oncologic outcomes to be discussed in a future publication.

In this trial, 541 patients were randomized to either RN (273) or PN (268) for an organ confined renal mass suspicious for RCC, 5 cm or less in size. The authors then examined complication rates associated with each procedure. They noted there was no difference in the rate of pleurotomy (9.3% RN versus 11.5% PN) or splenic injury (0.4% for both) between the two groups. There was a higher incidence of bleeding complications associated with PN. Blood loss less than 0.5 liters was 96% for RN and 87.2% for PN (p less than 0.001). Severe hemorrhage (greater than 1 liter) was also higher in the PN group (3.1%) versus the RN group (1.2%). Not surprisingly, the incidence of urinary fistula was significantly higher in the PN group (4.4%) versus the RN (0%) group (p less than 0.001). The reoperation rate for complications was also higher for the PN group (4.4% versus 2.4% for the RN group). Regarding the benefits of PN, the mean and median postoperative serum creatinine was significantly higher in the RN group (1.6 and 1.5, respectively) when compared to the PN group (1.34 and 1.29, respectively) (p less than 0.0001).

In this randomized clinical trial, PN was associated with a slightly higher complication rate relative to RN, but also preserved significantly more functional nephron mass. While complications associated with PN can be daunting to the inexperienced practitioner, the benefit of preserved renal function should not be discounted. The demonstration of oncologic equipoise awaits further follow-up and reporting from this study.

Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R, for the European Organization for Research and Treatment of Cancer (EORTC) , National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) , Southwest Oncology Group (SWOG) , the Eastern Cooperative Oncology Group (ECOG)

European Urology
DOI: 10.1016/j.eururo.2006.11.013

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Written by Christopher G. Wood, MD, a Contributing Editor with UroToday.

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