Quality of life after surgery for localized renal cell carcinoma: comparison between radical nephrectomy and nephron-sparing surgery

Vassilis Poulakis, Ulrich Witzsch, Rachelle de Vries, Matthias Moeckel, Eduard Becht
Urology 2003, 62 (5): 814-20

OBJECTIVES: To compare the impact of radical nephrectomy and nephron-sparing surgery (NSS) for localized renal cell carcinoma on quality of life (QOL).

METHODS: Retrospectively, 357 patients who had undergone NSS (n = 158) or radical nephrectomy (n = 199) for localized renal cell carcinoma completed postal questionnaires, including measures of QOL with validated instruments (SF-36, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 [EORTC QLQ-C30]), the impact of the stress of cancer, fear of recurrence, and worry about having fewer than two normal kidneys. A subset of 51 patients diagnosed after 2000 were followed up prospectively for at least 1 year.

RESULTS: The mental and physical health composite scores were not significantly different from the validated norms for an age and sex-matched community sample. Although the type of operation had no influence on patients' overall QOL, all patients who underwent elective NSS showed a significantly greater score on physical function than patients treated with radical nephrectomy (P <0.001). Predictors for higher scores included elective NSS, comorbidity (assessed with standardized checklist), tumor size, and time since nephrectomy. The overall QOL scores and recovery of stress from cancer in patients treated with NSS for tumor less than 4 cm with a normal contralateral kidney were significantly superior to those who underwent NSS for tumor greater than 4 cm (P <0.05). Patients questioned after mandatory NSS were significantly more concerned about cancer recurrence.

CONCLUSIONS: Patients without evidence of disease have relatively normal physical and mental health after operative treatment for localized renal cell carcinoma, independent of the kind of surgery. The QOL correlates proportionally with the size of tumor and is significantly better for patients undergoing NSS for tumor less than 4 cm with a normal contralateral kidney.

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