Open Partial Nephrectomy or Radical Laproscopic?

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Comments

  • icemantoo
    icemantoo Member Posts: 3,361 Member
    APny said:

    Wishing you the best, Limno.

    Wishing you the best, Limno. But as I said, if the choice is open partial vs. radical lap, well, no way would I want to lose a whole kidney if partial could be done. I did have sign that during surgery a partial could turn into a full one, but of course that's unknown until they're in there. I felt very comfortable with my choice to go with the open partial and would choose it again. Everyone's recovery is different so I'm hoping yours will be as relatively easy as mine was. Did you go for a second opinion?

    Size of tumor

    Limno,

     

    One of the factors in the equation is the size of the tumor. 5 cm is on the high side for a partial.

     

    Icemantoo

  • APny
    APny Member Posts: 1,995 Member
    icemantoo said:

    Size of tumor

    Limno,

     

    One of the factors in the equation is the size of the tumor. 5 cm is on the high side for a partial.

     

    Icemantoo

    According to the American

    According to the American Cancer Society it can be performed for tumors up to 7 cm, depending on where it is located. Here’s a quote:

    “Partial nephrectomy is now the preferred treatment for many people with early stage kidney cancer. It is often done to remove single small tumors (those less than 4 cm across), and can be done in patients with larger tumors (up to 7 cm across). Studies have shown the long-term results to be about the same as those when the whole kidney is removed. The obvious benefit is that the patient keeps more of their kidney function.

    A partial nephrectomy may not be an option if the tumor is in the middle of the kidney or is very large, if there is more than one tumor in the same kidney, or if the cancer has spread to the lymph nodes or distant organs. Not all doctors can do this type of surgery. It should only be done by someone with a lot of experience”

    http://www.cancer.org/cancer/kidneycancer/detailedguide/kidney-cancer-adult-treating-surgery

     

  • Limno
    Limno Member Posts: 24
    APny said:

    Wishing you the best, Limno.

    Wishing you the best, Limno. But as I said, if the choice is open partial vs. radical lap, well, no way would I want to lose a whole kidney if partial could be done. I did have sign that during surgery a partial could turn into a full one, but of course that's unknown until they're in there. I felt very comfortable with my choice to go with the open partial and would choose it again. Everyone's recovery is different so I'm hoping yours will be as relatively easy as mine was. Did you go for a second opinion?

    Second Opinion

    I will be seeing my family doctor and another doctor I am acquainted with to get their take on my situation.  The Urologist I am dealing with works out of an office with 5 partners.  Each case is reviewed by the partners and a decision is made by the group as to the best way to procede.  However, the patient ultimately has the final say.  I still have around 3 weeks to go.  My pre surgical consult will take place on March 10, so there is lots of time.  The waiting is no easy matter either but it gives one a chance to come to terms with everything.  Once again thanks for your thoughts and kind words

     

  • Limno
    Limno Member Posts: 24
    icemantoo said:

    Size of tumor

    Limno,

     

    One of the factors in the equation is the size of the tumor. 5 cm is on the high side for a partial.

     

    Icemantoo

    size of tumor

     

    I will be sure to ask about that

  • marosa
    marosa Member Posts: 334 Member
    Limno said:

    Second Opinion

    I will be seeing my family doctor and another doctor I am acquainted with to get their take on my situation.  The Urologist I am dealing with works out of an office with 5 partners.  Each case is reviewed by the partners and a decision is made by the group as to the best way to procede.  However, the patient ultimately has the final say.  I still have around 3 weeks to go.  My pre surgical consult will take place on March 10, so there is lots of time.  The waiting is no easy matter either but it gives one a chance to come to terms with everything.  Once again thanks for your thoughts and kind words

     

    I had the partial

    I wanted  ALL of my right kidney OUT but waiting for my operation and having a second talk with my Dr. I chose the partial.  I don't know how recup is different from partial. I did have a hard time AND complications but 5 months after, Im happy to have opted for this solution.  Anyway, I was told it was not a promise and he would know once he was operating.  Im going on my firts follow up next week and feel a bit anxious but mostly positive.   Go for the partial if its a possibility,  maybe more traumatic but it's worth it!   GOOD LUCK!  Get Well!

  • Limno
    Limno Member Posts: 24
    marosa said:

    I had the partial

    I wanted  ALL of my right kidney OUT but waiting for my operation and having a second talk with my Dr. I chose the partial.  I don't know how recup is different from partial. I did have a hard time AND complications but 5 months after, Im happy to have opted for this solution.  Anyway, I was told it was not a promise and he would know once he was operating.  Im going on my firts follow up next week and feel a bit anxious but mostly positive.   Go for the partial if its a possibility,  maybe more traumatic but it's worth it!   GOOD LUCK!  Get Well!

    Partial

    I am getting more used to the fact I have a tumor. When I accepted that, I realized my first choice of having a faster cleaner less painful procedure with a shorter hospital stay might not be my best option.  Over the last two weeks I have had: a renal efficiency test; a body scan; ct scans with and without contrast; an ultrasound as well as Blood and urine tests.  The results will tell me what the next step will be.  Your support and personal stories are getting me through this.  

  • APny
    APny Member Posts: 1,995 Member
    Limno said:

    Partial

    I am getting more used to the fact I have a tumor. When I accepted that, I realized my first choice of having a faster cleaner less painful procedure with a shorter hospital stay might not be my best option.  Over the last two weeks I have had: a renal efficiency test; a body scan; ct scans with and without contrast; an ultrasound as well as Blood and urine tests.  The results will tell me what the next step will be.  Your support and personal stories are getting me through this.  

    While there are no guarantees

    While there are no guarantees that yours will go the same way as mine, I was only in the hospital for two days. Surgery Monday, home on Wednesday. So as far as shorter hospital stay with the lap than the open, that's not necessarily true. And personally, when you have five incisions, no matter how small, your chances of infection are greater than when you have just one. But it's ultimately your surgeon's decision based on those test results like you said. If he does give you a choice between open partial or lap radical, well, like I said before, no way would I want to lose a whole kidney.

  • aamdsi
    aamdsi Member Posts: 284
    a little late

    Coming into this.

    I had an open partial almost a year ago (Monday marks the 1 year mark).  They did that as a opposed to a lap. because they were hoping only to take part of the kidney and said that an open was the best way for that.  But it also afforded them the ability to see the whole kidney and take it all if they had too.

    They only took 40%!! 8-)

    I was up and moving the next day, but stayed 5 days in hospital due to a reaction to the narcotics (I was really sick on them and they wouldn't pull me off).  But once off the drugs, I was out and feeling fine.

    Started taking slow long walks (mainly due to ice and snow on sidewalks) the next morning and was driving by end of week.  Within 2 months was back traiing and did my first Triathlon 4 months later. (I am 54)

    Granted we are all different and people's recoveries are going to be varied...but as long as the end result is the same (happy, "healthy", and aroiund for another decade...) it really matters not...does it?

    Sending you warm wishes.  Oh and just looking at your stat.s, I too had a 5m T1b tumur.  Now I just have a 10" scar 8-)

    Laurie

     

  • Footstomper
    Footstomper Member Posts: 1,237 Member
    aamdsi said:

    a little late

    Coming into this.

    I had an open partial almost a year ago (Monday marks the 1 year mark).  They did that as a opposed to a lap. because they were hoping only to take part of the kidney and said that an open was the best way for that.  But it also afforded them the ability to see the whole kidney and take it all if they had too.

    They only took 40%!! 8-)

    I was up and moving the next day, but stayed 5 days in hospital due to a reaction to the narcotics (I was really sick on them and they wouldn't pull me off).  But once off the drugs, I was out and feeling fine.

    Started taking slow long walks (mainly due to ice and snow on sidewalks) the next morning and was driving by end of week.  Within 2 months was back traiing and did my first Triathlon 4 months later. (I am 54)

    Granted we are all different and people's recoveries are going to be varied...but as long as the end result is the same (happy, "healthy", and aroiund for another decade...) it really matters not...does it?

    Sending you warm wishes.  Oh and just looking at your stat.s, I too had a 5m T1b tumur.  Now I just have a 10" scar 8-)

    Laurie

     

    I must be a slacker

    Full nephrectomy May 2013. Didnt get out until mid June. Physical therapy every other day. Walking down the garden path to the road. walking down the road to a corner. Walking round the corner and then round the block. Taking the dog for a walk. Going back to work as a teacher walking with a cane.

    Still walking with the cane and everybody tells me I'm doing well. Walking about 5 miles a day. A triathlon is NOT on my agenda

  • aamdsi
    aamdsi Member Posts: 284
    You're no "slacker"!!

    Footstomper!

    We are all different.  I just had it easier than you.  But YOU survived!  You are here and that is all that counts!

  • DonMiller
    DonMiller Member Posts: 109
    aamdsi said:

    You're no "slacker"!!

    Footstomper!

    We are all different.  I just had it easier than you.  But YOU survived!  You are here and that is all that counts!

    Open Partial

    I didn't have the option ( 11CM Stage 3 grade 3) but would have chosen an open partial.  I am 59, my CFR is now 56 and I have mild diabetes. Apparently this increases the risk of heart desease and stroke and I would perferred my kidney had a little help.  Although the immediate recovery from a laproscopic procedure is obviousily a lot quicker, full reocvery in the sense of getting back most of your energy and being able to reallly live is not that different.  As long as you have netfliz and a bottle of percocets I think you might consider the open partial.

     

    Don

  • RichardB63
    RichardB63 Member Posts: 59
    Limno said:

    I fought my insurance......

    Thanks. I am thinking along the same lines as you. When I asked the surgeon which choice he would make for himself he said he would endure the Pain and go for the partial. If I can rationalize and fully buy into the decision then dealing with the pain is secondary. Your name says it all : Positive Mental Attitude

    Thank you for your thoughts 

    Partial versus radical

           It's a lot to take in. I was given 4 choices by Dr. Wood at MD Anderson, 1. Watch it   2. I believe it was some type of freezing it???   3. Radical full nephrectomy  (he said he didn't recommend any of these).  Number 4 was an open partial (that could turn into a radical) according if something was irregular.   I had a 3.7 cm tumour on my right kidney and was convinced that I needed a full radical nephrectomy and asked him several times.    He was kind enough to quote several studies, I still wasnt convinced and researched it.  I chose what he recommended, he said he liked the open better because he had better access. I was 48 at the time and the recovery wasn't to bad.  I was back to work in 10 weeks, off pain meds in a month.   I remember having a wrap for my abdomen (coughing and such) and the fatigue was bad the first month or so.   Just a thought but I would choose the surgery that my surgeon feels the most comfortable doing...   I wouldn't want to be the first, or choose a surgeon that does it.  Two years out and I do as much as I ever did, walking and a bunch of water and listen to your body  (bunches of naps the first couple of months).   Good luck and best wishes.

    Richard   

  • Limno
    Limno Member Posts: 24
    DonMiller said:

    Open Partial

    I didn't have the option ( 11CM Stage 3 grade 3) but would have chosen an open partial.  I am 59, my CFR is now 56 and I have mild diabetes. Apparently this increases the risk of heart desease and stroke and I would perferred my kidney had a little help.  Although the immediate recovery from a laproscopic procedure is obviousily a lot quicker, full reocvery in the sense of getting back most of your energy and being able to reallly live is not that different.  As long as you have netfliz and a bottle of percocets I think you might consider the open partial.

     

    Don

    Update

    I have been away from the board for a few weeks- so here is an update.  One of my CT scans found two small nodules on my left lung, the size of a pinhead.  The Urologist and my family doctor don't feel there is any reason to worry and will follow up in 6 months with another CT scan.  However, this discovery resulted in a two more CT scans (with contrast), an ultrasound, a full body scan along with a kidney function test along with blood and urine tests.

    During my first meeting with my Urologist, mid February he estimated surgery would be from the middle to the end of March.  When we met with him in early March he said he had things tentatively booked for the end of March.  We got a call from the hospital that I am booked for surgery April 10.  Sometime in the next week I will be meeting with the Anesthesiologist and Operating room nurse who will determine if any further tests will be needed. The delay is frustrating and disappointing. Waiting is tough.

    The tests show there is no evidence the cancer has spread.  The size of the tumor is between 5 and 6 cm which puts me in a gray area between an open or radical nephrectomy.  An open partial will leave me with 2/3 of my kidney by my surgeons estimate. I know there is a chance this could still turn into a radical nephrectomy but I decided to go this route, in no small part from advice I have recieved from all of you that have responded.  Thank you once again for your kind thoughts and advice.  It has helped me greatly. 

  • icemantoo
    icemantoo Member Posts: 3,361 Member
    Limno said:

    Update

    I have been away from the board for a few weeks- so here is an update.  One of my CT scans found two small nodules on my left lung, the size of a pinhead.  The Urologist and my family doctor don't feel there is any reason to worry and will follow up in 6 months with another CT scan.  However, this discovery resulted in a two more CT scans (with contrast), an ultrasound, a full body scan along with a kidney function test along with blood and urine tests.

    During my first meeting with my Urologist, mid February he estimated surgery would be from the middle to the end of March.  When we met with him in early March he said he had things tentatively booked for the end of March.  We got a call from the hospital that I am booked for surgery April 10.  Sometime in the next week I will be meeting with the Anesthesiologist and Operating room nurse who will determine if any further tests will be needed. The delay is frustrating and disappointing. Waiting is tough.

    The tests show there is no evidence the cancer has spread.  The size of the tumor is between 5 and 6 cm which puts me in a gray area between an open or radical nephrectomy.  An open partial will leave me with 2/3 of my kidney by my surgeons estimate. I know there is a chance this could still turn into a radical nephrectomy but I decided to go this route, in no small part from advice I have recieved from all of you that have responded.  Thank you once again for your kind thoughts and advice.  It has helped me greatly. 

    Nodules on the lung

    Limno,

     

    For what it is worth small nodules on the lung are usually harmless and not usually related to RCC. The only concern is if they are greater than 8mm or grow. That is much larger than a pinhead.

    I'm putting my money on a good CT Chest scan 6 months from now. Now lets get the open partial neph behind you.

     

     

    Icemantoo

  • APny
    APny Member Posts: 1,995 Member
    icemantoo said:

    Nodules on the lung

    Limno,

     

    For what it is worth small nodules on the lung are usually harmless and not usually related to RCC. The only concern is if they are greater than 8mm or grow. That is much larger than a pinhead.

    I'm putting my money on a good CT Chest scan 6 months from now. Now lets get the open partial neph behind you.

     

     

    Icemantoo

    I think you made the right

    I think you made the right decision. Preserving 2/3 of your kidney is great when you have that option. Yes, I too had to sign off that it may turn into a radical nephrectomy but fortunately it didn't. Hoping for the same good outcome for you.

  • SFBob
    SFBob Member Posts: 33
    Limno said:

    Update

    I have been away from the board for a few weeks- so here is an update.  One of my CT scans found two small nodules on my left lung, the size of a pinhead.  The Urologist and my family doctor don't feel there is any reason to worry and will follow up in 6 months with another CT scan.  However, this discovery resulted in a two more CT scans (with contrast), an ultrasound, a full body scan along with a kidney function test along with blood and urine tests.

    During my first meeting with my Urologist, mid February he estimated surgery would be from the middle to the end of March.  When we met with him in early March he said he had things tentatively booked for the end of March.  We got a call from the hospital that I am booked for surgery April 10.  Sometime in the next week I will be meeting with the Anesthesiologist and Operating room nurse who will determine if any further tests will be needed. The delay is frustrating and disappointing. Waiting is tough.

    The tests show there is no evidence the cancer has spread.  The size of the tumor is between 5 and 6 cm which puts me in a gray area between an open or radical nephrectomy.  An open partial will leave me with 2/3 of my kidney by my surgeons estimate. I know there is a chance this could still turn into a radical nephrectomy but I decided to go this route, in no small part from advice I have recieved from all of you that have responded.  Thank you once again for your kind thoughts and advice.  It has helped me greatly. 

    Here's one more thumbs-up for the decision you just made. I didn't have the option because of my tumor's location (achieving an acceptable "margin" would have required chomping into a critical vein), but if I had had that option, I would have definitely chosen it.

    I know there was some discussion about this earlier in this thread (I'm coming in late--just found this group now), but there is a "have your cake and eat it too" option if you are working with one of the surgeons who do robotic-assisted laparoscopic partials. My surgeon--who does do these--explained to me that the only advantage is a shorter recovery time--otherwise the quality of the outcome is the same.

    Good luck with your upcoming surgery!

  • butterfly wings
    butterfly wings Member Posts: 28
    SFBob said:

    Here's one more thumbs-up for the decision you just made. I didn't have the option because of my tumor's location (achieving an acceptable "margin" would have required chomping into a critical vein), but if I had had that option, I would have definitely chosen it.

    I know there was some discussion about this earlier in this thread (I'm coming in late--just found this group now), but there is a "have your cake and eat it too" option if you are working with one of the surgeons who do robotic-assisted laparoscopic partials. My surgeon--who does do these--explained to me that the only advantage is a shorter recovery time--otherwise the quality of the outcome is the same.

    Good luck with your upcoming surgery!

    Best of luck with whatever

    Best of luck with whatever decision you make.  

    My tumor measured 6.5 cm on US then 6cm on the CT scan and when they removed it it finally measured in at 4.5cm.  My initial response when I was told it was a tumor was to have everything removed ...even 2 mins before we went into surgery he went to discuss why he thought a radical was best course of action..my exact words to him were "just take the **** thing out" he replied ok let go take the **** thing out and lead me into the OR