Life Is About Taking Chances

I talked about this topic last August and now 14 months later, I am revisiting this option again. What am I referring to? It's the kidney surgery. Why revisit again? The are some developments that necessitate a review of this option.

Firstly, my RBC count is dropping with every blood test. Daily I am losing some amount of blood due to the kidney tumor. My face is quite pale and has lost its shine. The kidney tumor is giving me some pain, with increasing frequency. I sense that I am starting to lose some muscles again, a sign of cachexia may be around the corner. I don't think my body can handle the two main tumor sites of the lungs and the right kidney at the same time. My body is getting weaker by the day because I easily get tired nowdays.

The last time I gave this surgery a pass was that those patients who did the surgery, did not survive for more than 6 months. Also most urologists are reluctant to perform this surgery as it does not improve my chances of survival because the cancer has metastasized extensively to my lungs. From academic point of view a few urologists agree that the body will have less stress to deal with once the kidney tumor mass has been debulked. A check with a few very experienced specialist doctor friends, all recommend that I go for the surgery. Anyway, statistically, patients like me have an average survival period of 10 months. Initially my doctors said I would not survive 6 months, but here I am still breathing. Hopefully, I can achieve the same after surgery. Is this too much a risk to take? If it ain't broken, why fix it?

At this moment, it's just thoughts. It will take some months for me to ponder. I still have to discuss with my family members, especially my brother because I hope to spend one month at his house in Malacca after surgery to recuperate. Furthermore, the surgery if it happens, will take place at a private hospital in Malacca. If it happens, it will most likely be after Chinese New Year, sometime around March or later. So many ifs.

I am now doing further reading to see what developments have taken place in radical nephrectomy. Some information about this surgery.

Definition:
Open radical nephrectomy is defined as removal of the entire kidney with surrounding fat and adrenal gland via an open flank or abdominal incision.

Technique:
Under general anesthesia, the kidney is removed along with the surrounding structures such as the adrenal gland and lymph nodes. Occasionally, open radical nephrectomy requires removal of a rib or placement of a drainage tube within the chest cavity to complete the operation.

Candidates:
Candidates for open radical nephrectomy are generally patients with large kidney cancers that are greater than 10 cm (approximately 4 inches) in size. Also, patients who have had extensive prior surgery are good candidates for open radical nephrectomy as laparoscopy can be very challenging if there is a large amount of scarring in the space around the kidney. Finally, if there is evidence that the kidney cancer has involvement of organs around the kidney, then open radical nephrectomy is often the best procedure.

Advantages / Disadvantages:
The advantages of open radical nephrectomy is that the larger incision that is created allows the surgeon to deal with complex cancers, which involve structures around the kidney. Kidney cancer can involve organs around the kidney such as the pancreas, spleen, and liver. With open radical nephrectomy, the surgeon will have the best ability to access and control these structures if they are involved by the kidney cancer.

The disadvantages of open radical nephrectomy are predominantly related to short-term post-operative pain control as the procedure is four to five times more painful than the laparoscopic radical nephrectomy. Additionally, in comparison to laparoscopic radical nephrectomy, the open radical nephrectomy is typically associated with a longer recovery period and complete recovery.