Partial, Radical, Biopsy?

Hubby123,

There is no one right or wrong answer. Each Doctor was trained differently and approaches ech case a little different. At 6cm  it is at the upper end of a Partial. Yes there is some recurrance with partials.  No 2 partials are identical because of the size and location of the tumor. In my day 16 years ago there were no partials. The answer lies in which Doctor YOU are most comfortable wither. Others  will chime in with their thoughts.

icemantoo

A tumor that big causes mass effect (puts pressure)on the normal kidney calyces and has to be removed eventually regardless of benign/malignant so biopsy is not useful here imho.also bleeding is a risk associated with biopsy.

As a general rule ,partial nephrectomy is done if 40percent of kidney tissue is normal and can be saved.The decision to go for partial /radical is best made on the surgery table after surgeon directly visualises the tumor.

Partial should be preferred as it is associated with better kidney function in the future .Though there is a risk of incomplete resection of tumor.lymph nodes are also spared in partial nephrectomy and might harbour some tumor cells.

If you go ahead with radical nephrectomy you might want to get a Dtpa renogram done to assess the functioning of the other kidney(rt kidney in your case).this is all the more important if the normal kidney has some other pathology like stone/scar.

At the end remember life with 1 kidney is manageable.

It seems that you have as much information at this point to make a plan. We  didn't have a choice on the procedure. However, we were so comfortable with the surgeon and his experience that made our choice easier. Whatever you choose it sounds like it will be a good option. Good luck and positive thoughts to you and your wife.

Hubby123 said:

Thanks-after more research here is something I posted elsewhere

We have had 2 opinions on [what appears to be*] a 6cm RCC on wife's left kidney, stage 1b. No indications of spread, seems to be wholly contained to kidney. She is 46.

Stanford guy said if it were him he would go full and evaluate adrenal gland removal on the fly (tumor is adjacent to the adrenal gland). Did not advocate for biopsy.

UCSF lady said if it were her she'd probably get a biopsy and try to do partial.

Both doctors are very optimistic for long term results (i.e. live to normal age).

I think this probably relates to different philosphies; Stanford wants to whack it with a sledgehammer and UCSF wants to preserve healthy tissue in a younger patient.

I think after reading a lot we are leaning toward partial with UCSF (both doctors essentially said "we'll do whatever you want" but we are more comfortable with the UCSF doctor, based on a variety of "gut feel" and "UCSF said this and Stanford did not even discuss that" types of issues. UCSF doctor has done 1000 of these.).

Here is my logic on this, if anyone can poke some holes in this please do.

1) We will probably skip the biopsy. While UCSF doctor was not concerned about spreading via biopsy, the studies seem to indicate a 1/10000 chance of seeding. While clinically these are good odds, from a "worry perspective" they are not great. Also Stanford guy said that even if benign we probably want to get rid of it anyway. And at this size and how it presented on the MRI, there is like an 80% chance it IS cancer anyway.

2) If this has been growing for 10 years (both doctors estimated that) then this puts her in the "early onset" class and it seems that this puts her in the area where genetics might be a cause, which would indicate a higher chance of this recurring. 50/50 if it would recur in the other (currently healthy) kidney or what is left of the left kidney. If she has a full and it recurs in the remaining kidney, well, better to have options. In any event we'd have to monitor the crap out of her and both doctors advocated for genetic testing and so on, with later involvement of a medical oncologist, tumor boards, etc.

3) The rate of recurrence for both partial and full seems equivalent, which takes me back to point 2 above.

Any thoughts welcome here.

• I caveat this as there has been no biopsy but based on MRI it does not seem to be oncocytoma (benign), but you can't tell without tissue analysis.

Who's the Stanford guy?  I had Geoffrey Sonn as my surgeon and Dr. H. Gill was my urologic oncologist.

Truth be told, both institutions are great.  I went to Stanford because my choices, based on my insurance company's policies, were Seton Medical Center (I wouldn't send my worst enemy there), CPMC (not bad) or Stanford.  I took about 0.01 seconds to choose Stanford.  If you had thrown UCSF in the mix, it would have made the choice harder since we live about equisidtant between the two hospitals.

In terms of the procedure that will be done, I can't argue with wanting to have a procedure that saves the largest amount of healthy kidney tissue possible.  I chose that route and had a robotic partial. I also think ging with your gut and your comfort level with the surgeon is incredibly important, so I think you're making the right choice.  Your wife will go into the procedure with a lot of confidence in her medical team.

The only possible hole I can poke into your reasoning is that the sledgehammer approach is probably an almost sure thing in terms of getting the entire malignancy out, and then some.  But with the technology available and the fact that they do a pathology screening right in the operating chamber, there should be no reason the finesse approach doesn't have a similar outcome.

Hubby123 said:

I think I read it as tumor is

I think I read it as tumor is greater than or equal to 4cm ("(≥4 cm)"). Now you've got me wondering if I've forgotten all of my algrebra. Understand the complications (bleeding, infection, etc) are more likely.

Nothing wrong with your algebra. It did say greater or equal to 4 cm.