Tuesday, 12 September 2017

Should we operate? Yale doctor seeks to limit surgeries for small kidney tumors.

This article, quoted below,presents a slightly contraversial view, that it is not always worth operating when a patient has a tumour on their kidney.

Not all kidney cancers are killers, and many small tumors can be left alone or watched over time because there is a low risk they will become dangerous, according to Dr. Brian Shuch at the Yale School of Medicine.

While doctors can detect more tumors because of increasingly sensitive tools, such as MRIs, surgery to remove the cancer is not called for in many cases, said Shuch, an assistant professor of urology and radiology.

“Many of these small tumors are very indolent or wimpy — low grade or low aggressiveness and low potential to spread or cause harm,” Shuch said. As many as 90 percent of tumors smaller than 4 centimeters fall into this category. Some actually turn out to be benign, he said.

Most surgeons will remove any cancerous tumor they find, out of concern for the risk of it growing, but also because they have a financial incentive to operate, as well as a fear of legal liability, Shuch said. This aggressive approach isn’t necessary and can lead to other issues later in life, such as dialysis, he said.

The full article can be found here and is worth reading. In countries where the surgeon gets paid for each operation based on the time taken and difficulty of the operation, many patients may be paying for treatment that they don't actual need. In other countries with a free health service, the views expressed in this article are the normal way to work, to spread the health service's limited resources to cases that really need them.