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 New antibody analysis accelerates rational vaccine design
09.08.2018 | Scripps Research Institute

nachricht Distrust of power influences choice of medical procedures
01.08.2018 | Johannes Gutenberg-Universität Mainz

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: Robots as 'pump attendants': TU Graz develops robot-controlled rapid charging system for e-vehicles

Researchers from TU Graz and their industry partners have unveiled a world first: the prototype of a robot-controlled, high-speed combined charging system (CCS) for electric vehicles that enables series charging of cars in various parking positions.

Global demand for electric vehicles is forecast to rise sharply: by 2025, the number of new vehicle registrations is expected to reach 25 million per year....

Im Focus: The “TRiC” to folding actin

Proteins must be folded correctly to fulfill their molecular functions in cells. Molecular assistants called chaperones help proteins exploit their inbuilt folding potential and reach the correct three-dimensional structure. Researchers at the Max Planck Institute of Biochemistry (MPIB) have demonstrated that actin, the most abundant protein in higher developed cells, does not have the inbuilt potential to fold and instead requires special assistance to fold into its active state. The chaperone TRiC uses a previously undescribed mechanism to perform actin folding. The study was recently published in the journal Cell.

Actin is the most abundant protein in highly developed cells and has diverse functions in processes like cell stabilization, cell division and muscle...

Im Focus: Lining up surprising behaviors of superconductor with one of the world's strongest magnets

Scientists have discovered that the electrical resistance of a copper-oxide compound depends on the magnetic field in a very unusual way -- a finding that could help direct the search for materials that can perfectly conduct electricity at room temperatur

What happens when really powerful magnets--capable of producing magnetic fields nearly two million times stronger than Earth's--are applied to materials that...

Im Focus: World record: Fastest 3-D tomographic images at BESSY II

The quality of materials often depends on the manufacturing process. In casting and welding, for example, the rate at which melts solidify and the resulting microstructure of the alloy is important. With metallic foams as well, it depends on exactly how the foaming process takes place. To understand these processes fully requires fast sensing capability. The fastest 3D tomographic images to date have now been achieved at the BESSY II X-ray source operated by the Helmholtz-Zentrum Berlin.

Dr. Francisco Garcia-Moreno and his team have designed a turntable that rotates ultra-stably about its axis at a constant rotational speed. This really depends...

Im Focus: A molecular switch may serve as new target point for cancer and diabetes therapies

If certain signaling cascades are misregulated, diseases like cancer, obesity and diabetes may occur. A mechanism recently discovered by scientists at the Leibniz- Forschungsinstitut für Molekulare Pharmakologie (FMP) in Berlin and at the University of Geneva has a crucial influence on such signaling cascades and may be an important key for the future development of therapies against these diseases. The results of the study have just been published in the prestigious scientific journal 'Molecular Cell'.

Cell growth and cell differentiation as well as the release and efficacy of hormones such as insulin depend on the presence of lipids. Lipids are small...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Within reach of the Universe

08.08.2018 | Event News

A journey through the history of microscopy – new exhibition opens at the MDC

27.07.2018 | Event News

2018 Work Research Conference

25.07.2018 | Event News

 
Latest News

NRL's sun imaging telescopes fly on NASA Parker Solar Probe

13.08.2018 | Physics and Astronomy

UT-ORNL team makes first particle accelerator beam measurement in six dimensions

13.08.2018 | Physics and Astronomy

ASU astrophysicist helps discover that ultrahot planets have starlike atmospheres

13.08.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>