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Surgeon's Preferences Dictate Choice of Kidney Cancer Surgery
Date:3/10/2008

Candidates for less radical procedures may not be getting them, study says

MONDAY, March 10 (HealthDay News) -- A surgeon's skills and preferences may dictate treatment choices for kidney cancer more than clinical factors such as tumor size or the patient's general health, a new study finds.

This means many patients who are candidates for less radical surgical procedures, such as a partial nephrectomy where only part of the kidney is removed, may not be getting them, the California researchers said.

"The world of medicine is slow to incorporate new technology," acknowledged Dr. Patrick Lowry, an assistant professor of surgery at Texas A&M Health Science Center College of Medicine. "It's kind of like a family tree. When more people are trained in it, they go out and spread it to others."

"Partial nephrectomy is more difficult and has more potential complications, and people may shy away from it," added Lowry, who's also section head of laparoscopy and endourology at Scott & White Memorial Hospital in Temple.

Radical nephrectomy, or removing the entire kidney, remains the gold standard for treating early-stage kidney cancer. While the procedure has a greater than 90 percent cure rate, it increases the risk of developing chronic kidney disease, the study authors said.

Over the past two decades, partial nephrectomy and laparoscopy (minimally invasive surgery) have started to make inroads in the field. These newer alternatives are easier on the patient and equally effective at controlling the cancer, yet not used anywhere nearly as often as radical nephrectomy, the researchers noted.

"On a national level, less than half of patients are getting one or the other [partial nephrectomy or laparoscopy] for small tumors," said study author Dr. David Miller, a clinical instructor in urology at the University of California, Los Angeles. "The question is whether there's some reason at a pati
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