Posted by Marcian Antonio Manu on May 13, 1999 at 21:01:18:
In Reply to: Re: Yet another RCC posted by CLDing on May 13, 1999 at 12:03:54:
: Is there a previous postop CT to show that the left crus area was clear? 2x3 cm is not very big and unless it is discrete, what I wrote earlier about CT of adrenal gland will apply, and I will certainly go along with you to wait and rescan in 3 months. After all the chance of cure in such circumstances is only about 10% (adopting figures for so-called solitary recurrences, admittedly mainly colonic ca cases). Halstead's concept of cancer surgery still applies today. I am a pessimist in this area and would find a reason not to operate rather than to rush in, even if the CT is correct. I think informed consent is important in these difficult circumstances, especially warning patient that the whole operation may prove to be futile a few months after it is over. If I have to do it for this guy, it would be a left flank supra-12 approach.
Dr. Ding is very right. It must be reviewed the control CT(s) after the nephrectomy to appreciate the evolution of the lesion. If it was stabile, we can speak about waiting. (how could be stabile a lesion that did not exist during surgery, obviously it has been increasing). If it increases I think quickly surgery is necessary. 2X3 cm. lesion seems to be not too big. If his chances now are 10%, later they will be less than now. Frequently but not as a rule we use to practice a different approach than the previous one. I think a flank supra XII could be proper. I am still supporting my first indication - flank exploratory surgery and tumorectomy now.