Featured Research

from universities, journals, and other organizations

Mayo Clinic Says Open Nephron-sparing Surgery Remains The 'Gold Standard'

Date:
August 15, 2005
Source:
Mayo Clinic
Summary:
Urologists often view less-invasive surgery techniques as more desirable for the patient, but in a study of open nephron-sparing surgeries (NSS) from 1985 to 2001 at Mayo Clinic, researchers found that the "gold standard" of open surgery for kidney tumors should remain the first choice for many patients. The study appears online today in The Journal of Urology.

ROCHESTER, Minn. -- Urologists often view less-invasive surgerytechniques as more desirable for the patient, but in a study of opennephron-sparing surgeries (NSS) from 1985 to 2001 at Mayo Clinic,researchers found that the "gold standard" of open surgery for kidneytumors should remain the first choice for many patients. The studyappears online today in The Journal of Urology.

"By comparing the first decade of elective open surgeries with morecontemporary ones, we found that patient outcomes have greatlyimproved," says Michael Blute, M.D., Mayo Clinic urologist and leadinvestigator of the study. "This leads us to the understanding thatwhile there are some new treatment options out there, what was once theonly option (open NSS) is still quite often the best option."

Prior to 1985, open NSS was only done on patients with onekidney while patients with two kidneys and cancer in one automaticallyhad the entire kidney removed. In the mid-1980s, Mayo Clinic began touse open NSS to treat patients who still had a healthy second kidney.This led to increased quality of life and fewer patients whosubsequently had to resort to dialysis.

Since then, laparoscopy has evolved as another commonly used treatment,often considered superior in other types of surgery. Initial studiesshowed that laparoscopic NSS is feasible for small, easily accessiblekidney tumors, making it appear the more favorable option. However, Dr.Blute and his colleagues have found that may not be true for manycases, especially when large or complex tumors are involved. "It's verydifficult to safely and accurately remove a complex kidney tumor withlaparoscopic NSS," explains Dr. Blute, "and if you find some cancerremaining when you look at the tissue under the microscope, it isdifficult to remove more tissue like you can when doing an open NSS."

Dr. Blute and his co-investigators reviewed all open NSS proceduresperformed at Mayo Clinic between 1985 and 1995, and compared them tothose performed between 1996 and 2001. They found that the procedurehas gotten increasingly better results over time, and attributed thisto increased surgeon experience, improved anatomical imaging, andenhanced perioperative care. For example, hospital stay declined from amedian of seven days to five days, blood loss and transfused units ofblood significantly decreased, early complications declinedconsiderably, and urine leak occurrence was demonstrated in only 0.6percent (compared to previous reports as high as 17 percent). They alsofound declines in the rates of dialysis need and other long-termcomplications.

When studying the more recent surgeries, researchers also found thatopen NSS showed some benefits compared with laparoscopic NSS. Whilelaparoscopic NSS can often offer patients reduced postoperative pain,shorter hospital stays and smaller scars, it carries some risks thatopen NSS actually lessens. For example, Mayo Clinic surgeons needed toclamp the renal artery, stopping blood flow to the kidney, in only 50percent of open NSS surgeries. For the majority of similarly complexlaparoscopic NSS, this artery is clamped for durations typically muchlonger than those required for open NSS. The importance of limitingartery clamp times was indicated by fewer early surgical complicationsseen in patients with 20 minutes or less of stopped blood flow.

Dr. Blute's team concluded that open NSS remains the standard by whichother treatments should be evaluated. "While there is a definitebenefit for many patients with tumors on the kidney's surface to havelaparoscopy," says primary author R. Houston Thompson, M.D., "we findthat NSS via an open approach remains the best option for patients withcomplex kidney tumors. In addition, we are now performing open NSSthrough mini-incisions of less than five inches, which reduces pain andhelps with a speedy recovery."

This study reviewed records of all patients undergoing open NSS between1985 and 2001. The records were obtained from the Mayo ClinicNephrectomy Registry, which includes over 4,000 patients who underwenteither NSS or radical nephrectomies since 1970.

###

In addition to Dr. Bluteand his co-investigator, Dr. Thompson, the Mayo Clinic research teamincluded Bradley Leibovich, M.D.; Christine Lohse; and Horst Zincke,M.D., Ph.D.

To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories.


Story Source:

The above story is based on materials provided by Mayo Clinic. Note: Materials may be edited for content and length.


Cite This Page:

Mayo Clinic. "Mayo Clinic Says Open Nephron-sparing Surgery Remains The 'Gold Standard'." ScienceDaily. ScienceDaily, 15 August 2005. <www.sciencedaily.com/releases/2005/08/050811090653.htm>.
Mayo Clinic. (2005, August 15). Mayo Clinic Says Open Nephron-sparing Surgery Remains The 'Gold Standard'. ScienceDaily. Retrieved September 2, 2014 from www.sciencedaily.com/releases/2005/08/050811090653.htm
Mayo Clinic. "Mayo Clinic Says Open Nephron-sparing Surgery Remains The 'Gold Standard'." ScienceDaily. www.sciencedaily.com/releases/2005/08/050811090653.htm (accessed September 2, 2014).

Share This




More Health & Medicine News

Tuesday, September 2, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

U.N. Says Ebola Travel Restrictions Will Cause Food Shortage

U.N. Says Ebola Travel Restrictions Will Cause Food Shortage

Newsy (Sep. 2, 2014) The U.N. says the problem is two-fold — quarantine zones and travel restrictions are limiting the movement of both people and food. Video provided by Newsy
Powered by NewsLook.com
Get on Your Bike! London Cycling Popularity Soars Despite Danger

Get on Your Bike! London Cycling Popularity Soars Despite Danger

AFP (Sep. 1, 2014) Wedged between buses, lorries and cars, cycling in London isn't for the faint hearted. Nevertheless the number of people choosing to bike in the British capital has doubled over the past 15 years. Duration: 02:27 Video provided by AFP
Powered by NewsLook.com
Can You Train Your Brain To Eat Healthy?

Can You Train Your Brain To Eat Healthy?

Newsy (Sep. 1, 2014) New research says if you condition yourself to eat healthy foods, eventually you'll crave them instead of junk food. Video provided by Newsy
Powered by NewsLook.com
We've Got Mites Living In Our Faces And So Do You

We've Got Mites Living In Our Faces And So Do You

Newsy (Aug. 30, 2014) A new study suggests 100 percent of adult humans (those over 18 years of age) have Demodex mites living in their faces. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins