New to this forum

txbarton,

What concerns me about your Urologist is that he is only one dimensional. Obviously he is older and not trained recently as the Kidney Cancer specialists in the last 10 or 15 years are trained on these new techniques.. You want a surgeon familiar with laproscopic and robotic surgery so those options are on the table also. Ultimately you may or may not have an open procedure, but you want the decision based upon your tumor, its size and where it is located not what your surgeon is limited by. Although your urologist may be renowned he is not likely a Kidney Cancer specialist if he is limited to open surgery.

At 6cm your tumor is medium size. Certainly curable from surgery, but too large to watch and wait,

Good luck with your second opinion. At 6 cm get this done sooner than later.

Icemantoo

Galrim said:

6 cm is neither small nor large. The term small may have been used at the hospital as it sizewise would fall into the T1 category, which by definition is the "smallest" category. However, as Iceman also states, in layman terms its medium sized (also medically I guess since its borderline T2).

As for your urologist dismissing partial neph on a 6 cm mass, get not only a second opinion, but get a new urolgist. Unless the location on the CT images gives a very good reason to conduct open surgery it shouldnt be necessary.

And you want to avoid open surgery for a number of reasons.

Good luck.

/G

I respectfully disagree that if a surgeon doesn’t do robotic or lap surgeries he’s not a kidney specialist. My surgeon at Sloan Kettering is highly regarded and is considered an expert in the field. He does not do robotic or lap surgeries, not because he’s unskilled or incapable, but for excellent reasons, which he fully explained to me during consultation. I was totally convinced that open was the only way to go. He is also an expert in partial nephrectomies, which many surgeons avoid due to its complicated nature. I’m not saying robotic and lap surgeries should be avoided, and for some cases they may be wonderful, but I don’t think a surgeon should be dismissed as not expert enough if he is not a fan of them. My open partial nephrectomy went very well and I was out of the hospital in 2 days. Get a second opinon for sure but don't dismiss surgeons who recommend open procedures.

foxhd said:

Me, on the other hand..

I had absolutely no concern of how they removed my tumor. I didn't care if they had to remove my head and go in that way. This is because I know that we will heal from anything that they can do to us. First concern should be of saving your life. The surgeon will determine what is most effective procedure. A few more weeks of recovery makes zero difference in the long term scope of things. I'm always surprised about people worrying what procedure will be used. Getting rid of the tumor should be the only concern.

Although their are a few experts out there who believe in or only do open surgeries their are others who only do open surgeries as they were not trained otherwise.

There is more than one right answer.

Icemantoo

I wouldn't call it small. The cutoff is 7cm for Stage 1 versus Stage 2. Without contrast, it's pretty hard to say if it's really 6cm. Even with contrast, mine was said to be 6cm and when my pathology came back it was 6.9cm. Perhaps the hospital is saying small relative to other things?

As I read other posts about the debate of open versus laproscopic, I realized the point is correct that there are urologists that don't do the laproscopic because they're "old school" and never been trained in it or don't have that capability where they practice, and then there are others possibly that have reasons not to do it. My surgeon said that studies had shown that it was as good/safe as open, but with benefits (less trauma so faster recovery). I know for my surgery, I had the laproscopy but I had a huge incision because he needed to remove the kidney intact (the tumor was large and sat in the center of the kidney, making it impossible to remove the kidney in sections). So my surgery was sort of a compromise between the two.

More important than open versus lap, is partial versus radical. Partials are more difficult and not everybody does them. I had to have a radical because of the location of the tumor. If you can get a partial, you may be spared some kidney function.

Getting another opinion is a really good idea. Try to get one from a urologic oncologist that does do laproscopic and ask both surgeons for their reasons so you can follow what they are recommending and why. I suggest you take a list of your questions and take someone with you so you get two sets of ears hearing the explanation. You'll have a much better chance of remembering what was said if someone else is present. Also, the surgeon often has a "team" with him when he comes in the room and it helps for you to have your support team with you to even things out. My experience was that when I had 1-2 people with me, the surgeon took more time to explain everything and I found that I was less nervous (maybe even intimidated) with my people to support me/witness the discussion.

Best of luck to you.

Todd

sblairc said:

Robotic: Surgeon with experience

Not all surgeons are trained in robotic surgery, nor want to be. Not all facilities within medical groups have them either, from what I understand. I think if you are interested in robotic as an option, make sure your surgeon is well versed and has many many surgical procedures under his belt. I noticed you mentioned robotic surgery for your prostate, so it sounds like you might know this already. 

It is my understanding open surgery requires cutting through layers of muscles and tissues not necessary during a laproscopic. This ultimately makes the surgerical recovery longer overall. I know it is common to "go in with the robot/lapro" but switch to open if necessary. My husbands tumor was measuring 8 cm ish on the CT and was about 7.5 ultmately and they were successful with a Robotic Lap. 

Fox, you and my husband had almost the same initial experience with the suddenness of the cancer (ER, then surgery). Honestly, they could have told us they were taking out the kidney with a Swiss army knife and a letter opener and we would have been "Sure, ok, great when is the surgery?" I think it's probably quite a different experience when there is plenty of time to think about it and prepare. 

 

The one bottom line is it all depends on the location of the tumor, which is equally as important as size.  A small tumor in the wrong spot and you get a radical.  A medium size tumor in the best spot opens the door for a partial.

I agree with Foxster.. don't matter how it is done, as long as it is done properly.  Partials can be tricky at times, and there is a very slightly greater risk of needing an additional procedure. Very slight..

Good Luck..!

Ron

Yes, it's much more complicated than a full so your surgeon has to be extremely experienced with partial nephrectomies. But if at all possible, try to go for one. Mine had no complication but I did have a drain in for a week. I was only in the hospital for 2 days (and mine was an open procedure) but came home with the drain. No biggie and I had no problems afterward. If you have to have an open procedure it's not horrible. I was out of bed and walking the same night as the surgery. Off morphene drip the next day and I can't say recovery was awful at all. No picnick but not horrible either. Go with whatever works for your particular case. As said, I didn't care what they did as long as they removed the little %$#@, lol.

foxhd said:

saving a kidney

Sounds like a really good idea. If possible. But, my mother had 2 kidneys and ended up on dialysis and died. My sister only had one kidney. She had dialysis and died. My kidney was removed and my creatinine is .9. It's as good as a healthy 20 yo with 2 kidneys. I'm glad my kidney is gone. I wouldn't want to offer a good hiding place for some mutant cells. The secret is beer and pizza I tell ya!

That's impressive. How do the doctors account for such a great number? (and don't say pizza and beer, LOL)

I had a full right nephrectomy.  The tumor was 7x5cm.   My surgeon was of the opinion that my otherwise healthy condition would make survival with one kidney easier than taking the chance on a partial removal. He never suggested a partial. Part of the complication for me was that there was uncertain involvement with my liver.  As it turned out there was no penetration into the liver. From what I have witnessed on the forum my open procedure did not take significantly longer to recover from than many of the partial robotics I have read about.....though it did leave beauty of a scar.

Go with the best advice of your doctors.  You will recover either way you go. I was out from work for a month but could probably have gone back after three weeks had i not had an abundance of sick leave.  Good luck TXbarton!

-Fox,  good one on ya .9 creatine.  I was happy with 1.48 recently.  I found an old blood work from 1991 recently and it showed my dual kidney creatine at 1.3 back in my healthiest days.

Skagway Jack said:

Mine was 7cm

I had a full right nephrectomy.  The tumor was 7x5cm.   My surgeon was of the opinion that my otherwise healthy condition would make survival with one kidney easier than taking the chance on a partial removal. He never suggested a partial. Part of the complication for me was that there was uncertain involvement with my liver.  As it turned out there was no penetration into the liver. From what I have witnessed on the forum my open procedure did not take significantly longer to recover from than many of the partial robotics I have read about.....though it did leave beauty of a scar.

Go with the best advice of your doctors.  You will recover either way you go. I was out from work for a month but could probably have gone back after three weeks had i not had an abundance of sick leave.  Good luck TXbarton!

 

 

-Fox,  good one on ya .9 creatine.  I was happy with 1.48 recently.  I found an old blood work from 1991 recently and it showed my dual kidney creatine at 1.3 back in my healthiest days.

 

 

 

I looked through my old blood tests in the year or two before my cancer was discovered and noticed that my creatinine had actually crept up (even though it was still "normal"). I wondered if anybody had noticed if that might have been an indicator that I had a large tumor growing in my kidney.

I'm happy if I get 1.6. Last year I had tests every 6 weeks for an entire year, and it varied from 1.6-1.8. Unfortunately, I have a lot of asymmetry in my body and the kidney with the tumor was quite a bit larger than the good kidney. In fact, they were worried I might not be ok with just the one, smaller kidney so they did a study before the nephrectomy to see how much work the right versus the left was doing.

One of my RCC buddies here has a creatinine of 1.1 with only 1 kidney. 0.9 is awesome.

I never thought I'd be envious of other guy's smaller (creatinine) measurements. Lol.

Todd

TX:  You should get a copy of the report that showed the tumor on your kidney.  The one from the hospital admission.  Read it for yourself to see where the tumor is and how big it is.  If you have to get the report from the institution, you might as well get a copy of the disc too.  You need this stuff for a second opinion.