Article Summary on Partial Nephrectomy (PN) vs. Radical Nephrectomy (RN)
The article chosen for this discussion focused on the study that was conducted on Partial Nephrectomy (PN) is associated with overall survival in patients compared to Radial Nephrectomy (RN) (Weight et al., 2010). According to this study, patients with localized renal masses who had partial nephrectomies have been associated with improved overall survival compared to those who received radical nephrectomies (Weight et al., 2010). The study was conducted to test the general survival rate of patients who had unexpected renal masses. Another objective of this study is to also study the effect of these procedures on cardiac specific survival rates and other causes of death related to decreased kidney function. The hypothesis for this study are that the use of partial nephrectomies would be first line of treatment compared to radical nephrectomies in that partial nephrectomies provide better protection of renal function. Decreased renal function will lead to a low survival rate. Patients who undergo radical nephrectomies will have higher rate of cardiac related deaths. Examining Data
A seven year, nonrandomized study was conducted using 499 participants. Of these 499 partakers, 111 patients received a radical nephrectomy while 388 patients received a partial nephrectomy. The cause of death information from the patients’ medical records was reviewed. From there the participants were further categorized by the condition that caused the death. Cardiac deaths ranged from death related to ischemic heart disease, CHF, ischemic stroke, myocardial infarction, ischemic stroke, and peripheral vascular disease. Renal deaths were broken down into death related to renal failure, renal insufficiency, or nephritic syndrome. All other possible causes of death were group together. Perioperative, postoperative data and renal function tests were collected before and after the procedures. Preoperative data was used to create the propensity model that was utilized in a multivariate model of survival. They measured the overall survival rate of the participants and cardiac specific survival rates. The risk of cardiovascular death was substantially higher in those with decreasing post-operative renal function. Decreased kidney function was connected to an increase in cardiovascular death and death from any other cause in overall majority patients. Sixteen participants died of cardiac related deaths. Renal preservation was increased in the group that had the partial nephrectomy with majority of the patients having an eGFR above 60 %. Radical nephrectomy participants only had an eGFR of 30 % or lower. On multivariate analysis, controlling for both comorbidity and age, RN was associated with a 2.5-fold increased risk of death compared to PN
