A More Objective Approach To Renal-Mass Surgery

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      4 Renal & Urology News               NOVEMBER 2009                                                                                                   www.renalandurologynews.com

                             FROM THE
                         MEDICAL DIRECTOR

                                                                                       EDITO RIAL ADVISO RY BOARD
          A More Objective Approach                                                    Medical Director, Urology
                                                                                       Robert G. Uzzo, MD, FACS
                                                                                                                                                             Medical Director, Nephrology
                                                                                                                                                             Kamyar Kalantar-Zadeh, MD, PhD, MPH

          To Renal-Mass Surgery                                                        G. Willing “Wing” Pepper Chair
                                                                                       in Cancer Research
                                                                                       Professor and Chairman
                                                                                                                                                             Associate Professor of Medicine
                                                                                                                                                             and Pediatrics, and Director,
                                                                                                                                                             Dialysis Expansion & Epidemiology
                                                                                       Department of Surgery                                                 Harbor-UCLA Division of
                                                                                       Fox Chase Cancer Center                                               Nephrology & Hypertension

                n the absence of level I evidence,                                     Temple University                                                     Los Angeles BioMedical Research
                physician treatment recommendations                                    School of Medicine                                                    Institute, The David Geffen School
                                                                                       Philadelphia                                                          of Medicine at UCLA
                are subject not only to the objective
          (interpretations of the cohort literature
          and practice guidelines) but also the sub-                                   Urologists                                                            Nephrologists
          jective (training patterns, comfort levels,                                  Frank R. Cerniglia Jr, MD                                             Suphamai Bunnapradist, MD
                                                                                       Attending Pediatric Urologist                                         Director of Research
          biases and individual experiences). Such                                     Children’s Urology of Virginia                                        Department of Nephrology
          is the case for management of the inciden-                                   Richmond, Va.                                                         Kidney Transplant Research Center
                                                                                                                                                             The David Geffen School of Medicine
                                                                                       Christopher S. Cooper, MD
          tal renal mass where multiple therapeutic                                    Director, Pediatric Urology
                                                                                                                                                             at UCLA
          options exist (J Urol. 2008;179:1227-1233).                                  Children’s Hospital of Iowa                                           Garabed Eknoyan, MD
                                                                                       Iowa City                                                             Professor of Medicine
          This is well highlighted in recently released guidelines from the            Michael Grasso, MD                                                    Baylor College of Medicine
          American Urological Association ( J Urol. 2009;182:1271-1279;                Chairman, Department of Urology
                                                                                       Saint Vincent’s Catholic Medical Centers                              Csaba P. Kovesdy, MD
          www.auanet.org/guidelines).                                                  New York City                                                         Assistant Professor of
            When considering how best to excise a renal tumor (laparoscopic/           R. John Honey, MD                                                     Clinical Internal Medicine
                                                                                       Head, Division of Urology,                                            University of Virginia
          robotic or open/partial or radical), the decision is profoundly affected     Endourology/Kidney Stone Diseases                                     Charlottesville
                                                                                       St. Michael’s Hospital                                                Chief of Nephrology
          by the surgeon’s subjective assessment of the anatomical attributes of the   University of Toronto                                                 Salem VA Medical Center
          renal tumor in the context of his/her experience. A lesion that one cli-     Stanton Honig, MD
                                                                                                                                                             Salem, Va.

          nician may deem “inappropriate” or even “impossible” for a partial ne-       Associate Clinical Professor of                                       Edgar V. Lerma, MD, FACP, FASN, FAHA
                                                                                                                                                             Clinical Associate Professor of Medicine
          phrectomy due to its “central”, “hilar,” or “endophytic” location, may       University of Connecticut                                             Section of Nephrology
                                                                                       School of Medicine, Urology Center                                    Department of Medicine
          be “standard” for another clinician. This has resulted in overutilization    New Haven                                                             University of Illinois at Chicago
          of radical nephrectomy with profound implications for the development                                                                              College of Medicine
                                                                                       J. Stephen Jones, MD, FACS                                            Chicago
          of CKD (Lancet Oncol. 2006;7:735-740).                                       Department of Regional Urology                                        Allen Nissenson, MD
            Equally importantly, comparing outcomes and developing metrics             Cleveland Clinic                                                      Emeritus Professor of Medicine
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