Our Summary

This paper is about a review and analysis of previous studies on two types of surgery for large kidney tumors: partial nephrectomy (PN) and radical nephrectomy (RN). The researchers looked at studies published up until January 2019 to compare these two methods.

They found 11 studies that included a total of 19,281 patients to analyze. The results showed that the tumors were generally smaller in the patients who had the PN surgery. Those who had the RN surgery lost less blood, but the patients who had the PN surgery had to stay in hospital a bit longer and they were also more likely to have complications after the surgery.

However, the PN surgery was better for preserving kidney function and didn’t increase the risk of the tumor coming back or death from the tumor or from any other cause.

In conclusion, the researchers suggest that PN could be a good option for treating large kidney tumors because it helps to preserve kidney function and doesn’t increase the risk of the tumor coming back or death. However, they also warn that patients with a certain stage of kidney mass (T2 or greater) should be carefully selected for PN because of the higher risk of complications.

FAQs

  1. What are the two types of surgeries for large kidney tumors discussed in the study?
  2. What are the benefits and risks of partial nephrectomy (PN) compared to radical nephrectomy (RN)?
  3. Who are the patients that the researchers suggest should be carefully selected for partial nephrectomy (PN)?

Doctor’s Tip

A doctor might tell a patient considering nephrectomy that while partial nephrectomy may result in a longer hospital stay and more complications compared to radical nephrectomy, it is better for preserving kidney function and does not increase the risk of the tumor coming back or death. It is important to carefully consider the stage of the kidney tumor when deciding on the best surgical option.

Suitable For

Patients who are typically recommended for nephrectomy include those with large kidney tumors, especially those with stage T2 or greater kidney masses. These patients may benefit from partial nephrectomy in order to preserve kidney function and reduce the risk of tumor recurrence or death. However, careful selection and evaluation of patients for surgery is necessary to minimize the risk of complications.

Timeline

Before nephrectomy:

  1. Patient is diagnosed with a large kidney tumor through imaging tests.
  2. Patient discusses treatment options with their healthcare provider, including the possibility of nephrectomy.
  3. Patient undergoes pre-operative tests and evaluations to determine if they are a suitable candidate for surgery.
  4. Patient receives counseling on the potential risks and benefits of nephrectomy.

After nephrectomy:

  1. Patient undergoes surgery to remove the affected kidney, either through partial or radical nephrectomy.
  2. Patient may experience pain, discomfort, and fatigue in the immediate post-operative period.
  3. Patient is closely monitored for any complications or side effects of the surgery.
  4. Patient may need to stay in the hospital for a few days to recover.
  5. Patient is provided with instructions for post-operative care, including pain management and wound care.
  6. Patient may need to follow up with their healthcare provider for regular check-ups and monitoring of kidney function.
  7. Patient may experience improvements in symptoms related to the kidney tumor, such as pain or urinary issues.

What to Ask Your Doctor

Some questions a patient should ask their doctor about nephrectomy include:

  1. What are the potential risks and complications associated with partial nephrectomy compared to radical nephrectomy?
  2. How will my kidney function be affected by each type of surgery?
  3. What is the likelihood of the tumor coming back after either type of surgery?
  4. How long will I need to stay in the hospital after the surgery?
  5. What is the recovery process like for each type of surgery?
  6. Are there any long-term effects of either surgery that I should be aware of?
  7. Will I need any additional treatments or follow-up care after the surgery?
  8. How will my quality of life be impacted by each type of surgery?
  9. Are there any specific criteria that make me a better candidate for one type of surgery over the other?
  10. What is the success rate of each type of surgery in terms of removing the tumor and preventing its recurrence?

Reference

Authors: Li J, Zhang Y, Teng Z, Han Z. Journal: Minerva Urol Nefrol. 2019 Oct;71(5):435-444. doi: 10.23736/S0393-2249.19.03470-2. Epub 2019 Jul 8. PMID: 31287256