Evidence from Registry Aids Management of Kidney Masses
JUST FOUND THIS RESEARCH ARTICLE: THIS IS WHAT MY DOCTORS AND HOSPITAL NEW BEFORE THEY REMOVED MY LEFT KIDNEY, URETER AND LYMPH NODES FOR NO CONFIRMED CANCER BEFORE OR DURING SURGERY. HOW CAN THIS BE ACCEPTABLE? Society should DEMAND answers and accountability. I NOW LIVE WITH THE HORRORS OF SURVIVING SEPTIC SHOCK(from intestinal puncture during surgery), MULTIPLE ABDOMINAL HERNIAS AND CKD-STAGE 3.
REFERENCE ARTICLE FROM MAYO CLINIC WEBSITE> see link below for complete article.
Evidence from Registry Aids Management of Kidney Masses
Centers of excellence for renal surgery obtain optimal outcomes treating renal masses using a rapidly expanding suite of evidence-based therapies. The desired outcome is preserving as much renal function as possible while returning the patient to the highest quality of life. At Mayo Clinic, the Mayo Clinic Renal Nephrectomy Registry is a key resource for achieving this objective. It includes more than 30 years of renal cancer surgery outcome data that are used to identify successful techniques and guide therapeutic innovation.
Begun in 1970, the Mayo Clinic Renal Nephrectomy Registry tracks every patient who undergoes kidney surgery at Mayo Clinic in Minnesota — more than 7,000 patients to date, with only 3 percent lost to follow-up.
Clinical annotation from patients’ medical records is linked to the natural history of disease, including histologic, pathologic, and molecular presentations. A single urologic pathologist reviews tissue specimens, and a single statistician analyzes the data.
Because first-line therapy for all renal masses is open or minimally invasive surgery, referral to an advanced multidisciplinary surgical center offers patients the expertise and options needed to achieve best outcomes.
Small renal masses
Increasingly, small renal masses (SRMs) (ie, <7 cm) are found incidentally during abdominal computed tomography (CT) scans. In the past, radical nephrectomy has been the treatment of choice for SRMs. This practice is changing because of potential disadvantages of removal of the entire kidney to treat SRMs. Mayo Clinic urologists who helped develop the technique of partial nephrectomy, or nephron-sparing surgery (NSS), have been instrumental in demonstrating the effectiveness of NSS as a treatment option.
Nephron-sparing surgery
Data show that 20 percent to 25 percent of all SRMs are benign. As many as 66 percent are low-grade, or indolent, tumors, according to a 2003 Mayo Clinic study.
In 2008, Mayo published data demonstrating that the NSS survival rate is superior to that of radical nephrectomy, and in patients younger than 65 years, radical nephrectomy is strongly associated with decreased overall survival. The greater survival rate for NSS is generally attributed to benefits of preserved kidney function. Appropriate selection of patients for NSS focuses on size, location, and tumor growth pattern, with exophytic tumors generally suited to NSS and infiltrative tumors suited to radical nephrectomy.
Size, location, and tumor growth pattern important in selection of patients
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Mayo Clinic urologic surgeons reported on NSS in 798 patients by an open or a laparoscopic approach, with a cure rate of 98.3 percent. Key elements of Mayo Clinic's success with NSS are surgical technique and collaboration. Mayo urologic surgeons have developed multiple ways to minimize potential ischemic damage to the kidney during resection while facilitating complete tumor removal. Close collaboration with pathologists in the operative suite benefits patients by ensuring complete tumor resection with negative margins at the time of surgery.
Minimally invasive interventions
Minimally invasive approaches include laparoscopic robotic surgery and percutaneous thermally based treatments such as radiofrequency ablation and cryoablation surgery. These approaches are indicated in patients who are poor surgical candidates and in those with peripheral tumor, usually measuring less than 3 cm, remote from the ureter.
Mayo Clinic is at the forefront of developing both radiofrequency and cryoablation percutaneous therapies for SRMs. The largest studies of both have been reported by Mayo Clinic interventional radiologists, who continue to refine these techniques. Results show radiofrequency ablation provides 89 percent to 97 percent local tumor control. Cryoablation provides success rates from 88 percent to 99 percent, with the caveat that the follow-up periods of the studies are short.
Late-stage, aggressive, node-positive cancers
These tumors require complex surgical procedures that impact multiple organ systems. Patients with these tumors benefit from a multidisciplinary surgical team's expertise.
At many centers, the surgery is considered over once the kidney is resected. Data from Mayo Clinic's Renal Nephrectomy Registry, however, argue against this practice. Data show that when patients are selected for lymph node dissection, based on Mayo's algorithm for high-risk cases, node-positive disease is found at the time of dissection in 31 percent of cases. Mayo surgeons completely clear all regional lymph nodes when performing radical nephrectomy to improve detection of metastasis and continue to study the effects.
Chart tracking 10-year survival for radical and partial nephrectomy
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Metastatic disease
Since December 2005, multiple new drugs have been approved to treat metastatic renal cell carcinomas. Most inhibit angiogenesis to interrupt tumor blood supply and shrink growth. Patients tolerate them well.
Even so, for select patients Mayo Clinic researchers have consistently demonstrated the advantage of aggressive surgical resection of metastatic disease. Mayo's metastatic renal cell carcinoma patients receive the benefits of multidisciplinary care as needed from specialists in medical oncology, radiation oncology, and all fields of surgery.
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