Kidney cancer: radical nephrectomy preferred to partial, but infers long term negative impact on health and survival

Introduction: The study’s objective was to examine the effects of renal preservation surgery on long-term mortality, cardiovascular outcomes, and renal-related outcomes. Methods: We performed a retrospective cohort study of all partial (n=575) and radical nephrectomies (n=882) for tumors ≤7 cm in diameter between 2002 and 2010 across three academic centers in Ontario, Canada. We linked records from provincial databases to assess patient characteristics and outcomes (median seven years’ followup using retrospective data). A weighted propensity score was used to reduce confounding. The primary outcome was all-cause mortality. Secondary outcomes included hospitalization with major cardiovascular events, non-cancer related mortality, kidney cancer-related mortality, and dialysis. Results: Mean one-year postoperative estimated glomerular filtration rate (eGFR) was 71 mL/min/1.73 m2 in the partial group and 52 mL/min/1.73 m2 in the radical group. Partial nephrectomy was associated with a lower risk of all-cause mortality in the first five years after surgery (hazard ratio [HR] 0.42; 95% confidence interval [CI] 0.27–0.66), which did not extend beyond five years (HR 1.01; 95% CI 0.68–1.49). Kidney cancer-related mortality was lower in the partial compared to the radical group for the first four years after surgery (HR 0.16; 95% CI 0.04–0.72). There were no significant differences between the groups for cardiovascular outcomes or non-cancer related deaths. Conclusions: Overall survival and cancer-specific survival was reduced in radical nephrectomy patients. However, despite reduced renal function in the radical nephrectomy group, non-cancer -related death, cardiovascular events, and dialysis were not significantly different between groups. Long-term benefits of partial nephrectomy may be less than previously believed.

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Long-term results of surgical treatment for stage cT1 kidney cancer

Vestnik of Russian military medical Academy ◽

10.17816/brmma75476 ◽

2021 ◽

Vol 23 (3) ◽

pp. 133-140

Author(s):

Sergey A. Rakul ◽

Pavel N. Romashchenko ◽

Kirill V. Pozdnyakov ◽

Nikolay A. Maistrenko

Keyword(s):

Overall Survival ◽

Surgical Treatment ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Radical Nephrectomy ◽

Long Term Results ◽

Positive Surgical Margin ◽

Open Approach ◽

Invasive Approach

Studied herein are the long-term results after surgical treatment of stage cT1 kidney cancer. The study includes 278 surgeries for kidney tumors. Partial nephrectomy was performed in 199 (71.6%) cases and radical nephrectomy in 79 (28.4%). Surgeries were performed using the open, laparoscopic, and robotic approaches. Surgical treatment and long-term oncological results were studied. Open approach for partial nephrectomy was used in 2.01% of cases, laparoscopic in 27.64%, and robotic in 70.34%; and radical nephrectomy in 2.53%, 87.34%, and 10.13%, respectively. Incidence postoperative complications after partial and radical nephrectomy were 16.58% and 3.8%, respectively. Сomplications (Clavien Dindo 3) occurred in 11.56% and 3.8% cases, respectively. Positive surgical margin occurred after partial nephrectomy in 1.51%, whereas undetermined for radical nephrectomy. The 5-year disease-free survival for partial and radical nephrectomy was 94.98 1.77% vs. 86.96% 4.11%; 5-year overall survival was 96.2% 1.55% vs. 88.15% 3.96%; 10-year overall survival was 90.82% 4.19% vs. 76.32 6.1%; and 5-year cancer-specific survival was 99.16% 0.84% vs. 94.09% 2.87%, respectively. Our study demonstrates that partial nephrectomy is a safe and effective method for surgical treatment in stage cT1 kidney cancer. A minimally invasive approach is a priority. The nephron-sparring technique demonstrates superior long-term results compared with radical nephrectomy.

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Re: Long-Term Survival Following Partial vs Radical Nephrectomy Among Older Patients with Early-Stage Kidney Cancer

The Journal of Urology ◽

10.1016/j.juro.2012.07.128 ◽

2012 ◽

Vol 188 (5) ◽

pp. 1723-1724

Author(s):

David F. Penson

Keyword(s):

Kidney Cancer ◽

Radical Nephrectomy ◽

Older Patients ◽

Early Stage ◽

Term Survival ◽

Long Term Survival

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The interplay of gender, social context, and long-term unemployment effects on subjective health trajectories

BMC Public Health ◽

10.1186/s12889-021-10324-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Laura Altweck ◽

Stefanie Hahm ◽

Holger Muehlan ◽

Tobias Gfesser ◽

Christine Ulke ◽

...

Keyword(s):

Life Satisfaction ◽

Social Context ◽

Negative Impact ◽

Subjective Health ◽

Short Term ◽

Self Rated Health ◽

Health Trajectories ◽

Lower Baseline ◽

Baseline Values

Abstract Background While a strong negative impact of unemployment on health has been established, the present research examined the lesser studied interplay of gender, social context and job loss on health trajectories. Methods Data from the German Socio-Economic Panel was used, which provided a representative sample of 6838 participants. Using latent growth modelling the effects of gender, social context (East vs. West Germans), unemployment (none, short-term or long-term), and their interactions were examined on health (single item measures of self-rated health and life satisfaction respectively). Results Social context in general significantly predicted the trajectories of self-rated health and life satisfaction. Most notably, data analysis revealed that West German women reported significantly lower baseline values of self-rated health following unemployment and did not recover to the levels of their East German counterparts. Only long-term, not short-term unemployment was related to lower baseline values of self-rated health, whereas, in relation to baseline values of life satisfaction, both types of unemployment had a similar negative effect. Conclusions In an economic crisis, individuals who already carry a higher burden, and not only those most directly affected economically, may show the greatest health effects.

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