The treatment you get for kidney cancer depends strongly on which doctor you choose, according to a recent review article. Surgeons apparently like to do what they are most familiar with, regardless of the characteristics of the patient and the illness.
The most common surgery for kidney cancer (renal cell carcinoma) confined to a single organ is removal of the entire kidney, using traditional methods to cut the patient open. An alternative is laparoscopic surgery, in which the surgeon cuts smaller incisions and uses a camera inside the body to see what he or she is doing. Carbon dioxide is used to inflate the body cavity for viewing purposes. This surgery is also called minimally invasive. It requires more expensive equipment and more training for the surgeon, so the operation itself is costs more than traditional surgical methods. However, the patient generally recovers more quickly, with less expense for hospital care.
Partial nephrectomy is another option. This is removal of the tumor and some of the surrounding kidney tissue, leaving the remainder of the kidney functional. This technique was developed for patients with only one functional kidney. The success was high enough that some surgeons now use it for patients who still have a healthy kidney on the other side. For patients with reduced kidney function, partial nephrectomy can offer significantly better long-term results.
Laparoscopic partial nephrectomy is the most technically advanced option. This is used in a small minority of cases. It offers the benefits of both minimally invasive surgery and preservation of kidney function.
Researchers identified 5,483 Medicare beneficiaries who received surgery for kidney cancer from 1997 to 2002. They analyzed the data in terms of patient characteristics, choice of physician, and type of surgery. The patient characteristics were age, sex, race, marital status, location, income, education, tumor size, and other health conditions. Choice of physician was the most significant factor correlated with the type of surgery.
The authors of Reference 1 suggest that many patients, especially those old enough to be on Medicare, could benefit from wider use of laparoscopic and partial nephrectomy surgery techniques. But your doctor may not tell you this if his or her practice is focused on the traditional method of open radical nephrectomy. A second opinion could provide valuable information on your options.
by Linda Fugate, Ph.D.
References:
1. Miller DC, Saigal CS, Banerjee M, Janley J, Litwin MS, “Diffusion of surgical innovation among patients with kidney cancer”, Cancer 2008 April 15; 112(8): 1708-1717.