There were 151 radical nephrectomies and 45 partial nephrectomies, with the notable fact that 22 "planned" partial nephrectomies were subsequently converted to radical nephrectomy due to "intraoperative" and surgeon related factors. With a median follow-up of 21 months, there was 1 treatment failure in the partial nephrectomy group and 20 in the radical nephrectomy group. All partial nephrectomies had negative surgical margins at the time of surgery. The initial analysis performed in this study suggested that there was a benefit for partial nephrectomy however a subsequent analysis was performed using planned partial nephrectomy (intended operation at time of surgical exploration) as a variable. In this new analysis, the hazard ratio was 1.06 (p=0.9). Of note, the serum creatinine at 3 months post-operatively was significantly lower in the partial nephrectomy group.

The basic message of this paper is that when partial nephrectomy can be safely and effectively performed in tumors that are 4-7 cm, it is oncologically not inferior to radical nephrectomy. The fact that 22 patients were converted from partial to radical nephrectomy at the time of surgery demonstrates the need for careful patient selection in offering partial nephrectomy to patients with tumors in this size range.

Dash A, et al., BJU Int 97: 939-945, 2006

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

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