Dr. Linda Upchurch
November 12, 2012
Are kidney patients who received a partial nephrectomy at a lower risk of impaired renal function and cardiac related death compared to those who received a radical nephrectomy? When a patient is diagnosed with kidney damage, a surgical nephrectomy is often performed. Kidney damage may be caused by blocked blood vessels, kidney stones, masses, infection, and/or kidney cancer. With this procedure the kidney damage may be treated and also prevent further damage. A partial nephrectomy is a surgical procedure to remove a portion of the kidney. Partial nephrectomies are normally done laparoscopically with hand assistance or with robot assistance. A radical nephrectomy involves removing the kidney and the adrenal glands. A radical nephrectomy may be done laparoscopically or by open abdominal surgery. My patient was diagnosed with damage of the left kidney. Blood tests were performed and the patient was found to have a toxic WBC granulation. This toxic granulation led infection, inflammation and sepsis. An abdominal and pelvic CT scan found a 7.8 x 5.6 x 6.2 cm, solid, enhancing left lower pole renal mass and parasitic vessels in the infected area. A hand assisted partial laparoscopic nephrectomy was performed. They removed the lower portion of her left kidney. The kidney was to be tested for malignancy. The concern with my patient is that she has a past medical history of hypertension, anemia, and deep vein thrombosis. She is at an increased risk of further cardiac and renal complications. I believe these factors influenced the doctors’ decision to perform a partial nephrectomy instead of taking the radical approach. To find research on this kidney condition, I accessed the Galileo database. I searched for information on ways to treat renal masses and kidney cancer. I found multiple articles about laparoscopic and radical (open) nephrectomies. I found many articles that discussed the differences between the two and the affects they have on patients who receive them. I found an interesting study called “Partial Nephrectomy Is Associated with Improved Overall Survival Compared to Radical Nephrectomy in Patients with Unanticipated Benign Renal Tumours.” I found it interesting because it was relevant to the health issues that were being addressed with my patient. There millions kidney patients who undergo these procedures each year. I wanted to discover which procedure provided the best outcome for my patient and others with similar kidney problems. Purpose
According to this study, “a partial nephrectomy has been associated with improved overall survival in patients with localized renal masses compared to those who received a radical nephrectomy” (Weight, 2010). The purpose of this study is to test the overall survival rate of patients who had unanticipated renal masses. Another objective of this study is to also study the effect of these procedures on cardiac specific survival rates and other causes of death related to decreased kidney function. Hypothesis
The hypothesis for this study are that the use of partial nephrectomies would be first line of treatment compared to radical nephrectomies in that partial nephrectomies provide better protection of renal function. Decreased renal function will lead to a low survival rate. Patients who undergo radical nephrectomies will have higher rate of cardiac related deaths Design
A seven year, nonrandomized study was conducted using 499 participants. Of these 499 particiapants, 111 patients had received a radical nephrectomy while 388 patients received a partial nephrectomy. The choice of which surgery to do was left of the surgeon and the patient’s preferences. They took into consideration the mass size, the appearance, the...