Kidney Cancer Outcomes and Nephron-sparing Surgery
Peter Langenstroer, MD, MS, Professor of Urology, Director of Urologic Oncology
The management of kidney cancer has changed dramatically over the past 20 years. Whereas kidney cancer primarily remains a surgical disease, the techniques for surgical management have significantly improved and, in turn, have improved patient outcomes. Prior to the mid to late 1990’s, the standard of care for most patients with kidney cancer was kidney removal. In the latter part of that decade, it was recognized that partial removal of the kidney for patients with small kidney tumors could be safely performed without compromising cancer-specific survival. Despite this finding, it was another five to 10 years before a strong push for nephron-sparing surgery was embraced. This was due in part to the complexity of partial kidney surgery. With emerging data as to the long-term benefits of nephron-sparing surgery, we have witnessed a dramatic paradigm shift in the management of patients with small kidney cancers in the last five years. The new standard of care is nephron-sparing surgery.
It is important to our patients and the mission of the Department of Urology to provide nephron-sparing surgery to every patient who may be a candidate. Nephron-sparing surgery is typically performed by an open surgical approach, robotic-assisted laparoscopic approach, or by tumor
ablation using cryosurgery. In an effort to understand our utilization of nephron-sparing surgery, we looked at the State of Wisconsin inpatient database from July 2007 to January 2009. This offered us the unique ability to evaluate the utilization of nephron-sparing surgery at Froedtert & The Medical College of Wisconsin compared to statewide averages. We found the statewide average for partial nephrectomies was 28 percent. For
hospitals performing more than 50 kidney operations, the partial nephrectomy rate was 30 percent. Froedtert & The Medical College performed 141 such procedures with a nephron-sparing partial nephrectomy rate of 44 percent. When including cryosurgical procedures, the kidney preservation rate is 60 percent. This demonstrates that we have developed a kidney cancer program that parallels the national trend of most other major cancer centers around the country. The Department of Urology has firmly embraced the concept of nephron-sparing surgery to afford our patients the best possible outcomes.