Open Partial Nephrectomy or Radical Laproscopic?

Limno

Hi everyone,  a 5 cm T1b tumor was found on the lower lobe of my left kidney last week while looking for a kidney stone. Surgery is scheduled in about a month, in the meantime I am scheduled for a variety of tests and imaging to ensure that it is localized and there are no further surprises.  My question is the surgeon has allowed me to decide whether to have a radical nephrectomy laproscopically or an open partial nephrectomy.  My inclination is to preserve as much as I can and opt for a open partial nephrectomy but looking at the longer recovery period and greater pain involved during recovery is this the best choice?  I am 61 years old, in relatively good physical condition although I probably could lose 20 pounds. Luckily, I am retired so I don't have to return to work or be anywhere in particular. However, I have been told to expect a 3 month recovery with a open partial relative to 6 weeks in addition to longer hospital stay and of course addtional discomfort.  I have only just retired and this wasn't on my bucket list.

icemantoo

It is like a choice between 2 ugly sisters.

Limno,

 

I had the radical laproscopic 12 and 1/2 years ago just after my 59th birthday. Not fun. They were not doing partials then. I am a little shy about trying an open partial on my other kidney just so I can answer your question.

 

There is always a chance when the game is on that a gametime decision is made to convert a partial to a full and a laproscopic to an open.

 

There is no "better" choice. The partial and open are each more cutting and on the other hand it is nice to have more kidney function as we get older.

 

Others here may have an opinion one way or the other as to their favorite, but in my opinion this decision has to be made between you and the doctor after listening to the pros and cons of each.

 

Icemantoo

 

jason.2835

He can't do a partial laproscopically?

Limno,

It sounds like your doctor isn't totally comfortable doing laproscopic surgery.  I had the benefit of having a very proficient doc in robotic surgery; my anatomy forced him to turn a partial into a radical after he went in.  I'm not sure where you are located, but you shouldn't just have 2 choices; you should have the option of having your cake and eating it, too.  If possible, I would find a doctor who is more proficient in laproscopic procedures; from what I have read a partial nephrectomy via lapro is totally doable. 

If that's impossible, I can say that even though a radical wasn't the plan for me, I haven't really had any problems with one kidney.  I'm 35 and this just happened 4 months ago, so obviously I need to get used to a new way of life, I guess.  But I don't feel a whole lot different.  If your other kidney is in good shape and you are relatively healthy, don't automatically rule out a radical.  To me, the peace of mind is a little bit better knowing that, even though my tumor was only 2.8cm, a diseased organ has been removed.  I mean, that's what it was, right?

Positive_Mental_Attitude

I fought my insurance company

I fought my insurance company to have an open partial nephrectomy at a hospital and by a doctor of my choosing.  My primary reason was that I had extensive abdominal scars from prior abdominal surgeries.  While it is true that you do not need both kidneys, I wanted to keep both kidneys.  My doctor is a crusader for open partial nephrectomies.

As far as recovery time, I was feeling really well after 3 weeks.  I was 47 at the time of surgery.  The first 2-3 days after surgery were rough, but on day 4 I started walking 6 miles per day, and I think that hastened my recovery.  That is not to say that will work for you.  But I know several folks (and there are many here) who had open partial nephrectomies, and their recovery times were not bad. I think that the open partial gets a bad rap.  The way my doctor explained it, is it was easier for him to perform an open partial, particulalry because my tumor was located in a tricky location.

I am biased, but I would go for the open partial.

todd121

Partial Lap?

I'm with Jason. Why no partial option with a laproscopy? I do think there are docs that do them. Maybe get a second opinion?

I went to my local medical school's urology department and found a great surgeon very skilled in robotic laparascopic surgery. But I had to have a radical because of where my tumor was.

Preserving kidney is good if you can.

Mine was done as a laparoscopy, but I ended up with a very large 6" incision for removing the kidney. It's something they call a combination or something like that. I was back at work in 6 weeks.

Todd

Positive_Mental_Attitude

todd121 said:

Partial Lap?

I'm with Jason. Why no partial option with a laproscopy? I do think there are docs that do them. Maybe get a second opinion?

I went to my local medical school's urology department and found a great surgeon very skilled in robotic laparascopic surgery. But I had to have a radical because of where my tumor was.

Preserving kidney is good if you can.

Mine was done as a laparoscopy, but I ended up with a very large 6" incision for removing the kidney. It's something they call a combination or something like that. I was back at work in 6 weeks.

Todd

Todd,  I hope you are doing

Todd,  I hope you are doing well with your latest treatment.  As I said above, I am heavily biased towards open partial.  The way it was explained to me, and perhaps APny can fill in details is that performing an open surgery enables the doctor to access tumors in a difficult location.  Every surgeon is different, and perhaps there are surgeons that can do a lap procecure and access tumors in a difficult location.  But my surgeon convinced me that open provided more degrees of freedom during the surgery, and that made sense to me.  Robotic/laparoscopic surgery is growing in popularity, and perhaps in the future open surgeries may not be an option. 

200005098

It's a tough choice...

I had a tumor rupture within my kidney so I wasn't given the choice, and had to have radical nephrectomy laproscopically.   My tumor was slightly over 7cm and I was surprised they didn't have to change to open nephrecrony because of the size.  I was told that might happen once they started.  I was 39 at the time.  I was very active, ran 9-12miles per week and went to gym 3 times per week.  I was shocked at how difficult the surgery was.  I had surgery in Oct and was barely back to work in Jan.  I have a desk job but I was so worn out I could barely get in 4-5hrs.

I've read the other comments and I'm pretty amazed at some people's recovery.  I only posted because I didnt have the opportunity to prepare myself for the surgery.  I was hospitalized for 4 days living on pain meds and then had the surgery.  Maybe my recovery was tough because I had a tumor that ruptured and I was so sick leading up to the surgery.  I found this was much more difficult to recover from then I could have imagined.  When I was released (4-5days) I couldn't even get in and out of bed.  I rented a hospital bed that raised and lowered.  I couldn't do simple tasks like putting on socks, bras, wearing anything with a waist band!  Even eating was difficult.  I was excited the day I finally walked to my mailbox, probably a week and a half after surgery.  I just want to share that it is tough, I think any opportunity to have a less invasive surgery is worth considering.

 

I wish you all the luck...

Positive_Mental_Attitude

200005098 said:

It's a tough choice...

I had a tumor rupture within my kidney so I wasn't given the choice, and had to have radical nephrectomy laproscopically.   My tumor was slightly over 7cm and I was surprised they didn't have to change to open nephrecrony because of the size.  I was told that might happen once they started.  I was 39 at the time.  I was very active, ran 9-12miles per week and went to gym 3 times per week.  I was shocked at how difficult the surgery was.  I had surgery in Oct and was barely back to work in Jan.  I have a desk job but I was so worn out I could barely get in 4-5hrs.

I've read the other comments and I'm pretty amazed at some people's recovery.  I only posted because I didnt have the opportunity to prepare myself for the surgery.  I was hospitalized for 4 days living on pain meds and then had the surgery.  Maybe my recovery was tough because I had a tumor that ruptured and I was so sick leading up to the surgery.  I found this was much more difficult to recover from then I could have imagined.  When I was released (4-5days) I couldn't even get in and out of bed.  I rented a hospital bed that raised and lowered.  I couldn't do simple tasks like putting on socks, bras, wearing anything with a waist band!  Even eating was difficult.  I was excited the day I finally walked to my mailbox, probably a week and a half after surgery.  I just want to share that it is tough, I think any opportunity to have a less invasive surgery is worth considering.

 

I wish you all the luck...

200005098 (that's some

200005098 (that's some name!-like I should talk), you had quite a severe event, and no wonder you were laid up for so long.  We are all different, and our experiences are different.  I feel blessed and lucky my open surgery went so smoothly with a reasonable recovery time.  I remember being told I was not supposed to drive for a period of time, but I was driving not long after surgery.  Someone I know who went to the same surgeon as I did said he was pretty tired for 6 months after the surgery. 

Limno

jason.2835 said:

He can't do a partial laproscopically?

Limno,

It sounds like your doctor isn't totally comfortable doing laproscopic surgery.  I had the benefit of having a very proficient doc in robotic surgery; my anatomy forced him to turn a partial into a radical after he went in.  I'm not sure where you are located, but you shouldn't just have 2 choices; you should have the option of having your cake and eating it, too.  If possible, I would find a doctor who is more proficient in laproscopic procedures; from what I have read a partial nephrectomy via lapro is totally doable. 

If that's impossible, I can say that even though a radical wasn't the plan for me, I haven't really had any problems with one kidney.  I'm 35 and this just happened 4 months ago, so obviously I need to get used to a new way of life, I guess.  But I don't feel a whole lot different.  If your other kidney is in good shape and you are relatively healthy, don't automatically rule out a radical.  To me, the peace of mind is a little bit better knowing that, even though my tumor was only 2.8cm, a diseased organ has been removed.  I mean, that's what it was, right?

He can't do a partial laproscopically

 

I live in a rural area with the nearest city 5 hours away, so I will stick with the local surgeon.  You are right this tumor has to go-but getting your head around this whole situation is dauntin.  In two weeks I go from a guy who passes his first kidney stone to a cancer diagnosis to preparation for surgery.  It's a lot to absorb and I appreciate everyone's input. Thanks

Allochka

Positive_Mental_Attitude said:

200005098 (that's some

200005098 (that's some name!-like I should talk), you had quite a severe event, and no wonder you were laid up for so long.  We are all different, and our experiences are different.  I feel blessed and lucky my open surgery went so smoothly with a reasonable recovery time.  I remember being told I was not supposed to drive for a period of time, but I was driving not long after surgery.  Someone I know who went to the same surgeon as I did said he was pretty tired for 6 months after the surgery. 

My fiance had an open partial

My fiance had an open partial for his small tumor. his doctor said what docs of previous posters siad - it gives more freedom and opens " better view".  Each recovery case is different, but my fiance (aged 35) recovered very quickly, no severe pain, nothing, and resumed working in a month after surgery.

if I had to make a choice for myself - I would opt for open. It is cancer ater all, I'd better not leave anything to chance

Good luck!

Limno

icemantoo said:

It is like a choice between 2 ugly sisters.

Limno,

 

I had the radical laproscopic 12 and 1/2 years ago just after my 59th birthday. Not fun. They were not doing partials then. I am a little shy about trying an open partial on my other kidney just so I can answer your question.

 

There is always a chance when the game is on that a gametime decision is made to convert a partial to a full and a laproscopic to an open.

 

There is no "better" choice. The partial and open are each more cutting and on the other hand it is nice to have more kidney function as we get older.

 

Others here may have an opinion one way or the other as to their favorite, but in my opinion this decision has to be made between you and the doctor after listening to the pros and cons of each.

 

Icemantoo

 

It's like a choice between....

Appreciate your input.  There is so much to take into cosideration in such a short time.  I can't think about anyone better than to speak with those that have gone through this before.  I know that if I choose an open partial and things don't go as planned I could end up with plan c (an open radical nephrectomy =Murphys Law) with none of the benefits and all of the drawbacks.  When it comes to health care I'm a belt and suspenders guy so thats what draws me to the partial but having never had major surgery how do you quantify the pain and discomfort?

Limno

Positive_Mental_Attitude said:

I fought my insurance company

I fought my insurance company to have an open partial nephrectomy at a hospital and by a doctor of my choosing.  My primary reason was that I had extensive abdominal scars from prior abdominal surgeries.  While it is true that you do not need both kidneys, I wanted to keep both kidneys.  My doctor is a crusader for open partial nephrectomies.

As far as recovery time, I was feeling really well after 3 weeks.  I was 47 at the time of surgery.  The first 2-3 days after surgery were rough, but on day 4 I started walking 6 miles per day, and I think that hastened my recovery.  That is not to say that will work for you.  But I know several folks (and there are many here) who had open partial nephrectomies, and their recovery times were not bad. I think that the open partial gets a bad rap.  The way my doctor explained it, is it was easier for him to perform an open partial, particulalry because my tumor was located in a tricky location.

I am biased, but I would go for the open partial.

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 

Limno

200005098 said:

It's a tough choice...

I had a tumor rupture within my kidney so I wasn't given the choice, and had to have radical nephrectomy laproscopically.   My tumor was slightly over 7cm and I was surprised they didn't have to change to open nephrecrony because of the size.  I was told that might happen once they started.  I was 39 at the time.  I was very active, ran 9-12miles per week and went to gym 3 times per week.  I was shocked at how difficult the surgery was.  I had surgery in Oct and was barely back to work in Jan.  I have a desk job but I was so worn out I could barely get in 4-5hrs.

I've read the other comments and I'm pretty amazed at some people's recovery.  I only posted because I didnt have the opportunity to prepare myself for the surgery.  I was hospitalized for 4 days living on pain meds and then had the surgery.  Maybe my recovery was tough because I had a tumor that ruptured and I was so sick leading up to the surgery.  I found this was much more difficult to recover from then I could have imagined.  When I was released (4-5days) I couldn't even get in and out of bed.  I rented a hospital bed that raised and lowered.  I couldn't do simple tasks like putting on socks, bras, wearing anything with a waist band!  Even eating was difficult.  I was excited the day I finally walked to my mailbox, probably a week and a half after surgery.  I just want to share that it is tough, I think any opportunity to have a less invasive surgery is worth considering.

 

I wish you all the luck...

It's a tough choice

Thank you so much for your story. Having never had major surgery I don't know what to expect and having no symptoms makes this unexpected.  All I have been told is considerable pain; discomfort; and fatigue. But how do you quantiffy any of those things if you've never experienced it.  I really appreciate you taking the time for your thoughtful response and hope your ongoing recovery is swift

Limno

Allochka said:

My fiance had an open partial

My fiance had an open partial for his small tumor. his doctor said what docs of previous posters siad - it gives more freedom and opens " better view".  Each recovery case is different, but my fiance (aged 35) recovered very quickly, no severe pain, nothing, and resumed working in a month after surgery.

if I had to make a choice for myself - I would opt for open. It is cancer ater all, I'd better not leave anything to chance

Good luck!

My fiancé.......

Thank you for your thoughts  I am kind of on the same page, and want input from people that have walked this path before. It's kind of like an "experience Google for kidhey cancer". I wonder how my age (61) and extra 20 lbs around my waist will affect my recovery

Since I am still absorbing the fact I have a tumor and quickly have to make decisions on treatment it's great to be able to weigh all points of view through your experiences

Limno

200005098 said:

It's a tough choice...

I had a tumor rupture within my kidney so I wasn't given the choice, and had to have radical nephrectomy laproscopically.   My tumor was slightly over 7cm and I was surprised they didn't have to change to open nephrecrony because of the size.  I was told that might happen once they started.  I was 39 at the time.  I was very active, ran 9-12miles per week and went to gym 3 times per week.  I was shocked at how difficult the surgery was.  I had surgery in Oct and was barely back to work in Jan.  I have a desk job but I was so worn out I could barely get in 4-5hrs.

I've read the other comments and I'm pretty amazed at some people's recovery.  I only posted because I didnt have the opportunity to prepare myself for the surgery.  I was hospitalized for 4 days living on pain meds and then had the surgery.  Maybe my recovery was tough because I had a tumor that ruptured and I was so sick leading up to the surgery.  I found this was much more difficult to recover from then I could have imagined.  When I was released (4-5days) I couldn't even get in and out of bed.  I rented a hospital bed that raised and lowered.  I couldn't do simple tasks like putting on socks, bras, wearing anything with a waist band!  Even eating was difficult.  I was excited the day I finally walked to my mailbox, probably a week and a half after surgery.  I just want to share that it is tough, I think any opportunity to have a less invasive surgery is worth considering.

 

I wish you all the luck...

It's a tough choice.......

Thank you so much for your story. Having never had major surgery I don't know what to expect and having no symptoms makes this unexpected.  All I have been told is considerable pain; discomfort; and fatigue. But how do you quantiffy any of those things if you've never experienced it.  I really appreciate you taking the time for your thoughtful response and hope your ongoing recovery is swift

 

icemantoo

Limno said:

It's a tough choice.......

Thank you so much for your story. Having never had major surgery I don't know what to expect and having no symptoms makes this unexpected.  All I have been told is considerable pain; discomfort; and fatigue. But how do you quantiffy any of those things if you've never experienced it.  I really appreciate you taking the time for your thoughtful response and hope your ongoing recovery is swift

 

Another thought

Limno,

 

If available try and get a consult with a Nephrologist

Their whole focus is Kidney function.

Once you make your decision do not second guess it.

Neither surgery will be easy at age 61. Both will hurt a lot.

I thing is certain and that is that you have to get rid of this 5cm tumor to get on with yout life.

Best of luck with whatever you choose.

Keep us posted.

 

Icemantoo

 

 

Positive_Mental_Attitude

Limno said:

My fiancé.......

Thank you for your thoughts  I am kind of on the same page, and want input from people that have walked this path before. It's kind of like an "experience Google for kidhey cancer". I wonder how my age (61) and extra 20 lbs around my waist will affect my recovery

Since I am still absorbing the fact I have a tumor and quickly have to make decisions on treatment it's great to be able to weigh all points of view through your experiences

Limno, I would not worry

Limno, I would not worry about your age or the extra 20 pounds around your waist.  At the time of surgery, I was carrying an extra 30 pounds or so.  I got my diagnosis in very early May, and I initially considered postponing my surgery until September so that I could drop the weight prior to surgery.  I opted to get the surgery, and did so in early July.  I did not lose any weight prior to surgery, but after the surgery, with all of the walking, I lost about 8 pounds in July/August, only to gain back 12 more pounds at the end of the year.  I am attacking that weight gain now with diet and excercise, with some success.  As far as you age, 61 is not very old, and you should be fine with open surgery. 

I am sure this is a shock to your system.  I went through shock, denial, depression, fear, "why me?" and various other emotions prior to surgery.  The days before the surgery were the roughest for me, but looking back at it, I can laugh at myself.  The biggest fear is fear of the unknown, but the good thing for you is you found this forum, and you will find lots of folks who went through this surgery and are absolutely fine with no recurrence. 

APny

icemantoo said:

Another thought

Limno,

 

If available try and get a consult with a Nephrologist

Their whole focus is Kidney function.

Once you make your decision do not second guess it.

Neither surgery will be easy at age 61. Both will hurt a lot.

I thing is certain and that is that you have to get rid of this 5cm tumor to get on with yout life.

Best of luck with whatever you choose.

Keep us posted.

 

Icemantoo

 

 

I had the same surgeon at

I had the same surgeon at Sloan Kettering as Positive_Mental and yes, he recommended open partial instead of lap. His reasoning convinced me and I'm glad I opted for it. It had nothing to do with his lack of skills (surgeons at SK would have been more than qualified in doing lap surgeries). Many people's lap surgeries have turned into way longer procedures than my under 2 hours open surgery. My recovery was great. I was not in any extreme pain; very manageable with meds at first. I was home in two days. Surgery Monday and home on Wednesday. My incision is less than five inches. Others with lap have not only several smaller incisions but often a much larger main incision. I would choose open partial over radical lap anyday. Oh, and by the way I was 61 when they did the surgery so certainly no spring chicken.

Footstomper

APny said:

I had the same surgeon at

I had the same surgeon at Sloan Kettering as Positive_Mental and yes, he recommended open partial instead of lap. His reasoning convinced me and I'm glad I opted for it. It had nothing to do with his lack of skills (surgeons at SK would have been more than qualified in doing lap surgeries). Many people's lap surgeries have turned into way longer procedures than my under 2 hours open surgery. My recovery was great. I was not in any extreme pain; very manageable with meds at first. I was home in two days. Surgery Monday and home on Wednesday. My incision is less than five inches. Others with lap have not only several smaller incisions but often a much larger main incision. I would choose open partial over radical lap anyday. Oh, and by the way I was 61 when they did the surgery so certainly no spring chicken.

Surgeon

I would be guided by the surgeon. Presumably he knows what he is doing and you are a tumour virgin. If you're not sure a second opinion couldnt hurt could it?

Limno

APny said:

I had the same surgeon at

I had the same surgeon at Sloan Kettering as Positive_Mental and yes, he recommended open partial instead of lap. His reasoning convinced me and I'm glad I opted for it. It had nothing to do with his lack of skills (surgeons at SK would have been more than qualified in doing lap surgeries). Many people's lap surgeries have turned into way longer procedures than my under 2 hours open surgery. My recovery was great. I was not in any extreme pain; very manageable with meds at first. I was home in two days. Surgery Monday and home on Wednesday. My incision is less than five inches. Others with lap have not only several smaller incisions but often a much larger main incision. I would choose open partial over radical lap anyday. Oh, and by the way I was 61 when they did the surgery so certainly no spring chicken.

APny

I am relieved to hear good comments from you and Positive_Mental. There is a reason each of us has a certain treatment and we each react differently.  I was reading about difficulties from patients recovering from Partial Nephrectomy I was having a hard time rationalizing going that route. Since my diagnosis and first post; I have been through a series of tests to ensure the cancer hasn't spread and to determine the efficiency of each of my kidneys.  I think the results of these tests will make the choice of surgery a question that will be answered by reason rather than emotion.  I feel a lot more comfortable knowing people have had a good recovery with either surgery.  Thank you to everyone for your thoughts and support.

APny

Limno said:

APny

I am relieved to hear good comments from you and Positive_Mental. There is a reason each of us has a certain treatment and we each react differently.  I was reading about difficulties from patients recovering from Partial Nephrectomy I was having a hard time rationalizing going that route. Since my diagnosis and first post; I have been through a series of tests to ensure the cancer hasn't spread and to determine the efficiency of each of my kidneys.  I think the results of these tests will make the choice of surgery a question that will be answered by reason rather than emotion.  I feel a lot more comfortable knowing people have had a good recovery with either surgery.  Thank you to everyone for your thoughts and support.

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?