GU Cancers 2019 | Complete vs. partial nephrectomy for RCC

Hendrik Van Poppel

Hendrik Van Poppel, MD, PhD, of the University Hospitals Leuven, Leuven, Belgium, speaks at the 2019 Genitourinary Cancers Symposium, held in San Francisco, CA and discusses the pros and cons of both partial and complete nephrectomy in the treatment of renal cell carcinoma.

Transcript (edited for clarity):

I think we have strong data from one randomized clinical trial, which I was coordinating in the URTC in the early ’90s. We were willing to show that partial nephrectomy is as good as a radical nephrectomy to control cancer, which is obviously the case. While we spare more nephrons, we spare kidney function, so patients are less likely to need dialysis or substitution for their kidney function.

This is what we have all been doing for years, doing more and more partial nephrectomies and not doing laparoscopic radical nephrectomies, which often is a very safe procedure and would be enough in patients with a normal contralateral kidney. The indications for partial are absolutely the imperative patients that have one kidney, that have bilateral tumors, that have diminished kidney function, that have hypertension, that have diabetes. These are the patients that are likely to develop kidney failure, chronic kidney disease and these are the absolute indications for nephron-sparing surgery.

The problem is that by doing so, we have started also doing partial nephrectomies in patients that are healthy, that have a normal contralateral kidney and the question that we have today in the debate is, do we need to do that whenever possible? There is an argument not to do too complex tumors, not to do oncologically unsafe partial nephrectomies, because a radical nephrectomy is easy. Patients go home the day after. They have no local recurrences. They have no blood loss and, or complications.

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