Partial Versus Total Kidney Removal

For patients with kidney tumors, a new study shows the health and economic advantages to removing just the tumor as opposed to the entire kidney. Robotic surgery, including the daVinci Surgical System and Firefly fluorescence imaging that lights up kidney tumors, are among the latest techniques to make this possible.

March 5, 2013

New Study Finds Greater Survival and Cost Savings When Only the Tumor is Removed

(Washington, D.C.) – For patients with kidney tumors, a new study shows the health and economic advantages to removing just the tumor as opposed to the entire kidney. Robotic surgery, including the daVinci Surgical System and Firefly fluorescence imaging that lights up kidney tumors, are among the latest techniques to make this possible.

The retrospective study conducted by MedStar Georgetown University Hospital Urologist Keith Kowalczyk, MD, is published in the March issue of the British Journal of Urology International. It compares the effectiveness, costs and trends in the treatment of kidney tumors less than four centimeters in size. The study found that partial kidney removal, whether open or laparoscopic, leads to better overall survival and fewer health problems after surgery. Additionally, minimally invasive approaches to partial kidney removal resulted in to shorter length of hospital stay and lower costs.

“The study says that patients who underwent the partial kidney removal for kidney cancer tended to live longer because sparing the remaining kidney allowed them to avoid medical complications of kidney failure afterwards,” said Dr. Kowalczyk. “The more of the kidney you can keep, the more kidney function you’ll have after the tumor is removed, and the better you will do.”

“In the 1980’s and early 90’s the standard of care was to remove the whole kidney unless surgeons had other contra-indications for example if the patient only had one kidney or tumors on both sides,” said Dr. Kowalczyk. “Over the last 10 years, studies have suggested that partial kidney removal is just as good at curing the cancer as removing the whole tumor, and at the same time has the additional benefit of sparing crucial kidney function. This study reinforces on a greater scale that leaving the healthy part of the kidney benefits the patient in terms of cancer survival, overall survival, costs, and fewer postoperative complications. Additionally, doing the partial removal via a minimally invasive approach, when possible, leads to quicker recovery” said Dr. Kowalczyk.

Judith Morrisey, 37, had a robotic partial kidney removal, also known as a robotic partial nephrectomy, in May 2012 to remove a cancerous tumor. Morrisey, a nurse in the infusion center at MedStar Georgetown University Hospital never thought she would be a patient fighting cancer.

“I thought I had a stomach virus and went to the emergency room to receive fluids. I had a CAT scan which showed a small mass on my kidney, about one centimeter. I give patients chemotherapy everyday so the thought of me being sick cancer was a shock,” said Morrisey.

After meeting with Dr. Kowalczyk and hearing her options, Morrisey’s first concern was if she was going to be able to take care of her nine-month old son.

“My first thought was if I was going to be able to pick him up and carry him after surgery,” said Morrisey.

After receiving the partial kidney removal surgery with robotic surgery, Morrisey was able to leave the hospital within three days and returned to work a week later. After six months of follow up, Morrisey is back to her normal routine.

This study, based on 1,682 Medicare patients from twenty regions in the United States between 2005 and 2007, shows how partial nephrectomy for kidney tumors can also decrease healthcare costs and helps the overall healthcare system.

“Doing partial nephrectomy will absolutely decrease healthcare costs because there are going to be fewer patients with renal inefficiency or kidney failure afterwards. Additionally, minimally invasive surgery also leads to a shorter hospital stay and faster return to normal activities. That means fewer patients with overall problems and costly complications,” said Dr. Kowalczyk.

While this study looked at tumors four centimeters and smaller, 53-year-old Linda Rutledge had six centimeter cancerous kidney tumor that Dr. Kowalczyk was able to remove by performing a robotic partial nephrectomy, leaving the rest of her healthy kidney functioning.

“I thought I had an infection and with my doctor’s advice I received a CAT scan. Not only did the scan show a kidney stone in my right kidney, but it picked up another mass in my left kidney,” said Rutledge. “The first specialist I saw said because of the size of the tumor he would have to remove the whole kidney. However, he recommended I see Dr. Kowalczyk if I was interested in exploring a partial removal.”

After seeing Dr. Kowalczyk, Rutledge knew that the surgery would be difficult and that there was a 50% chance that a partial kidney removal would be possible due to the large size of her tumor.

“I asked him ‘If you were me what would you do?’ After hearing the advantages of the partial removal I told him to go for it, even though I knew it was a 50/50 chance [of saving the whole kidney],” said Rutledge.

Dr. Kowalczyk used the daVinci Robotic system to successfully remove just her 6 cm tumor. When the pathology results came back, Rutledge’s tumor was confirmed to be fast growing and cancerous, however was completely removed without any residual cancer.

“I was so excited that the surgery was successful. I was a smoker for 30 years and since the surgery I haven’t picked up a cigarette since. The whole experience really opened my eyes,” said Rutledge.

By publishing the study Dr. Kowalczyk hopes that patients can be informed about their options and that surgeons are encouraged to perform partial kidney removal when feasible, whether open or robotic, in order to spare crucial functioning kidney tissue.

“Patients should know they could have the option to save their kidney. We have better technology now like daVinci and Firefly that help us offer this surgery to people ten years ago,” said Kowalczyk.

About MedStar Georgetown University Hospital

MedStar Georgetown University Hospital is a not-for-profit, acute-care teaching and research hospital with 609 beds located in Northwest Washington, D.C. Founded in the Jesuit principle of cura personalis—caring for the whole person—MedStar Georgetown is committed to offering a variety of innovative diagnostic and treatment options within a trusting and compassionate environment.

MedStar Georgetown’s centers of excellence include neurosciences, transplant, cancer and gastroenterology. Along with Magnet® nurses, internationally recognized physicians, advanced research and cutting-edge technologies, MedStar Georgetown’s healthcare professionals have a reputation for medical excellence and leadership. MedStar Georgetown University Hospital—Knowledge and Compassion...Focused on You.

About MedStar Health

MedStar Health combines the best aspects of academic medicine, research and innovation with a complete spectrum of clinical services to advance patient care. As the largest healthcare provider in Maryland and the Washington, D.C., region, MedStar’s 10 hospitals, the MedStar Health Research Institute and a comprehensive scope of health-related organizations are recognized regionally and nationally for excellence in medical care. MedStar has one of the largest graduate medical education programs in the country, training more than 1,100 medical residents annually, and is the medical education and clinical partner of Georgetown University. MedStar Health is a $4.5 billion not-for-profit, regional healthcare system based in Columbia, Maryland, and one of the largest employers in the region. Its almost 30,000 associates and 6,000 affiliated physicians all support MedStar Health’s Patient First philosophy that combines care, compassion and clinical excellence with an emphasis on customer service.

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