Partial nephrectomy for small renal tumors

Partial nephrectomy rates in the U.S. are increasing, but seem surprisingly low even for the smallest renal tumors.  Approximately 80% of patients with tumors between 2 and 4 cm in size undergo total in lieu of partial nephrectomy.  Potential sources for this low rate include case mix, patient preference, and provider preference, among others. 

With discretionary surgery (that in which there are pros and cons with different treatments), patients should be informed of the tradeoffs and allowed to decide how to proceed.  Unfortunately, financial incentives in the US are misaligned to facilitate referral from a provider who does not offer a certain service to one who does.

Bibliographical reference:

Miller DC et al.: "Partial nephrectomy for small renal masses: an emerging quality of care concern?", J Urol. 2006 Mar;175(3):853-7

Brent K. Hollenbeck
Department of Urology, University of Michigan Medical Center, Ann Arbor, MI