Kidney cancer patients may be overtreated, U-M study finds

A less aggressive type of surgery designed to spare healthy organ tissue is used infrequently to treat early-stage kidney cancer, according to researchers at the University of Michigan Comprehensive Cancer Center.

A majority of patients with small kidney tumors have their entire kidney removed as treatment, even though they may be eligible for a type of surgery that removes only the cancer and spares the rest of the normal kidney. This surgery, called partial nephrectomy, has been associated with improved quality of life and better preservation of long-term kidney function.

Studies have shown that for tumors smaller than 4 centimeters, removing only the tumor and a small margin of healthy tissue is just as effective at controlling the cancer as removing the entire kidney, an operation called total nephrectomy. At the same time, by sparing the remainder of the affected kidney, patients may be less vulnerable to long-term declines in kidney function a concern particularly relevant for patients with other conditions that affect the kidneys, such as diabetes or high blood pressure. In addition, sparing a portion of the affected kidney creates more options if a new tumor develops in the patient's second kidney, a risk confronting a small number of people with kidney cancer.

The study looked at 14,647 people treated from 1988 to 2001 for kidney cancers less than 7 centimeters in size. Data was obtained from the Surveillance, Epidemiology and End Results (SEER) registry, which collects annual data about cancer incidence, treatment and mortality. Results of the study appear in the March issue of the Journal of Urology.

The researchers found that during this 13-year interval, only 9.6 percent of patients were treated with partial nephrectomy, while the remaining 90 percent had their entire kidney removed. The smaller the tumor, the more likely patients were to receive partial nephrectomy, although even among this group, partial nephrectomy wa


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