Surgical Options

 I have had renal insufficiency fdue to hypertension for about 10 years with about 35% function presently.   I had a CAT scan for a gastro problem in early September and a renal cell carcinoma which measures 2.0cm X 2.3cmX 1.7 cm was picked up incidentally..  I have gotten four different opinions and have two doctors I am comfortable with their expertise.  However, one of the two says a laproscopic partial nephrectomy is the answer and the other doctor favors an open partial nephrectomy.  I am scheduled for the laproscopic procedure on 11/19/7 but I continue to wonder if the open procedure is better in that it MAY be able to evaluate if the cancer is somewhere else? The open procedure has a significant time in the hospital as opposed to 3 days with the laproscopic procedure. Both doctors feel the likelihood of metasis is not great and the cancer is capsulated, but a small nodule in the lung was  also found on the CAT scan.  Both doctors say it has no significance at this point.Has anyone had this dilema before?

Please see a Clinical Oncologist, with Renal Cell Carcinoma expertise. I was diagnosed with a tumor on my kidney and the Dr. wanted to remove the kidney. I went to a specialist and he is treating the whole of my cancer not just the source. I would be suspicious of a nodule in the lung as that is exactly where mine moved to. Regardless, good luck and God go with you.

May I ask how large your tumor is or was? When you say the doctor is treating the whole of the cancer, can you tell me what he is doing,etc., that may be different? Thanks so much for your reply! It is greatly appreciated.

I don't remember its size from back last Jan. but I have been treated with Sutent and checked every 6 weeks with c/t scans and X-rays. The tumors in my lungs have shrunk along with the one on my kidney. I go to MD Anderson in Houston, TX

Did I understand this right? You just have it in one kidney, correct? If that is the case, I think you would take the entire kidney out and biopsy the lung or at the very least get another opinion.
Surgery with RCC is the best option when it is operable.

Thanks responding. I have both of my kidneys, I just have a total funcation of only 35% (which is still a long way from dialysis). I just don't know about the open procedure versus the laproscopic procedure...this tumor is still small at its size. Any thoughts?

I am not a doctor but it is my understanding that the doctors that perform the surgery laporascopically can/may ultimately perform open surgery if they decide during surgery that they need to do this. The laporascopic technique is a new technique and the recovery time is much quicker. My dad had his entire kidney removed laporascopically and was home within a week after surgery. Also, you should have the lung looked into - its best not to leave it. Good luck.

Laparoscopic partial nephrectomies are quicker to recover from but have an additional risk to the kidney because the time necessary to interrupt the blood supply to the kidney (called ischemic time) tends to be longer during a laparascopic surgery. Lap partials take a skilled surgeon; I would want to know that he or she has done at least 30, and that their ischemic time is around a half hour.