Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Radical surgery for kidney cancer is risk factor for chronic kidney disease

07.09.2006
For forty years, the gold standard for treating a single, small tumor in the kidney has been to remove the entire kidney. A retrospective study, which appears in the September issue of The Lancet Oncology, by urologists at Memorial Sloan-Kettering Cancer Center (MSKCC) and their colleagues, suggests that this practice needs to be re-evaluated.

Researchers add that with advances in imaging, almost 70 percent of kidney cancer patients have their tumor detected at a very small size (less than 4 cm), allowing surgeons to perform less radical surgery with superior results.

The study revealed that patients with two otherwise healthy kidneys who underwent kidney-sparing surgery (partial nephrectomy) to remove a small cancer developed chronic kidney disease at a rate one-third lower than patients whose entire kidney was removed (radical nephrectomy). The three-year probability of staying free of chronic kidney disease was 80 percent for the partial nephrectomy patients compared with 35 percent for patients who underwent a radical nephrectomy. In fact, radical nephrectomy was shown to be a significant risk factor for developing chronic kidney disease.

"The results of our study demonstrate that prior to surgery, the baseline kidney function of patients with small kidney tumors was significantly lower than previously recognized," explained Dr. William C. Huang, the study's first author. "Patients who undergo a radical nephrectomy, the most common treatment for small kidney tumors, are at significantly greater risk for the development of chronic kidney disease after surgery compared with those who undergo a partial nephrectomy."

The retrospective study of 662 patients at MSKCC showed that up to 26 percent of the patients had pre-existing chronic kidney disease before undergoing surgery to remove a small tumor (less than 4 cm) from the kidney. In addition, those patients who had the entire kidney removed were more than twice as likely to develop chronic kidney disease.

Although partial nephrectomies account for 30 to 65 percent of all kidney surgeries performed in tertiary care centers in the United States like MSKCC, the latest analysis from the Nationwide Inpatient Sample reported in the journal Urology indicated that 92.5 percent of all kidney cancer surgeries in the United States from 1998 to 2002 were radical nephrectomies. Statistics from the Department of Health in England for the same period reflected a similar trend. In 2002, 96 percent (2,671) of kidney cancer surgeries performed in England were nephrectomies and 4 percent (108) were partial nephrectomies.

"Evidence has accumulated from our Center and elsewhere that partial nephrectomy provides effective local tumor control and equivalent survival rates to that of radical nephrectomy for small tumors," said Dr. Paul Russo, the study's senior author. "However, while approximately 70 percent of kidney tumor operations at MSKCC are partial nephrectomies, national databases from the United States and abroad suggest that greater than 80 percent of patients may be unnecessarily undergoing the more radical surgery to remove the entire kidney, even for small renal tumors. One explanation may be that partial nephrectomy is a more complex surgical procedure."

A number of risk factors for chronic kidney disease, such as diabetes, hypertension, and smoking, are commonly found in patients with kidney tumors, and may account for why the majority of these patients are at risk for developing chronic kidney disease following a radical nephrectomy. Chronic kidney disease can result in the loss of kidney function, sometimes leading to kidney failure. Complications associated with chronic kidney disease include anemia, hypertension, malnutrition, and neuropathy, as well as a reduced quality of life, and even heart disease and death.

"Our study clearly demonstrates, for the first time, the serious effects on kidney function and the high risk of chronic kidney disease when an entire kidney is removed for a small cancer. Chronic kidney disease leads to an increased risk of cardiovascular events, hospitalizations, and even death," said Dr. Peter T. Scardino, Chairman of the Department of Surgery and co-author of the study. "By removing only the cancerous part, we are much more likely to preserve a patient's normal kidney function and avoid the long-term consequences of chronic kidney disease."

Joanne Nicholas | EurekAlert!
Further information:
http://www.mskcc.org

More articles from Health and Medicine:

nachricht Oxygen can wake up dormant bacteria for antibiotic attacks
08.12.2016 | Penn State

nachricht NTU scientists build new ultrasound device using 3-D printing technology
07.12.2016 | Nanyang Technological University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Significantly more productivity in USP lasers

In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.

Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...

Im Focus: Shape matters when light meets atom

Mapping the interaction of a single atom with a single photon may inform design of quantum devices

Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

Closing the carbon loop

08.12.2016 | Life Sciences

Applicability of dynamic facilitation theory to binary hard disk systems

08.12.2016 | Physics and Astronomy

Scientists track chemical and structural evolution of catalytic nanoparticles in 3-D

08.12.2016 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>