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Open Partial Nephrectomy or Radical Laproscopic?

Limno
Posts: 24
Joined: Feb 2015

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's picture
icemantoo
Posts: 3217
Joined: Jan 2010

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

 

Limno
Posts: 24
Joined: Feb 2015

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?

jason.2835
Posts: 337
Joined: Nov 2014

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?

Limno
Posts: 24
Joined: Feb 2015

 

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

Positive_Mental_Attitude's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

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.

Limno
Posts: 24
Joined: Feb 2015

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 

RichardB63's picture
RichardB63
Posts: 59
Joined: Oct 2012

       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   

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todd121
Posts: 1425
Joined: Dec 2012

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's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

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
Posts: 1
Joined: Feb 2015

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's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

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. 

Allochka's picture
Allochka
Posts: 869
Joined: Nov 2014

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
Posts: 24
Joined: Feb 2015

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

Positive_Mental_Attitude's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

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. 

Limno
Posts: 24
Joined: Feb 2015

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
Posts: 24
Joined: Feb 2015

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's picture
icemantoo
Posts: 3217
Joined: Jan 2010

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

 

 

APny's picture
APny
Posts: 1947
Joined: Mar 2014

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's picture
Footstomper
Posts: 1238
Joined: Dec 2014

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
Posts: 24
Joined: Feb 2015

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's picture
APny
Posts: 1947
Joined: Mar 2014

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?

icemantoo's picture
icemantoo
Posts: 3217
Joined: Jan 2010

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's picture
APny
Posts: 1947
Joined: Mar 2014

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
Posts: 24
Joined: Feb 2015

 

I will be sure to ask about that

Limno
Posts: 24
Joined: Feb 2015

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

 

marosa's picture
marosa
Posts: 332
Joined: Feb 2015

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
Posts: 24
Joined: Feb 2015

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's picture
APny
Posts: 1947
Joined: Mar 2014

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
Posts: 284
Joined: Apr 2014

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's picture
Footstomper
Posts: 1238
Joined: Dec 2014

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
Posts: 284
Joined: Apr 2014

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's picture
DonMiller
Posts: 109
Joined: Feb 2013

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

Limno
Posts: 24
Joined: Feb 2015

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's picture
icemantoo
Posts: 3217
Joined: Jan 2010

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's picture
APny
Posts: 1947
Joined: Mar 2014

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's picture
SFBob
Posts: 33
Joined: Mar 2015

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
Posts: 28
Joined: Mar 2015

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

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