This issue features a paper by Porter and Lange, “Controversies in the Surgical Management of Renal Cancer,” that highlights a major role for the oncology journal: examining the significant changes in treatment brought on by new technology. Taking on this task entails more than just describing the new procedure or device. To be of practical use to the clinician, the report must contain careful analysis of the multiple ramifications of introducing the new method or procedure.Radical nephrectomy has long been considered the appropriate management for renal cell cancer. Over recent years, increased use of partial nephrectomy and the introduction of laparoscopic techniques for performing radical nephrectomy have expanded the urologic oncologist's options. As one might suspect, the first consideration must be whether the new procedure is as good as the old in controlling the disease. In the case of the nephron-sparing procedure, observations in more than 2,600 patients indicate that for tumors less than 4 cm (and perhaps for tumors 4–7 cm), the control rates are the same as those achieved with the total organ excision. Similarly, multiple studies indicate that laparoscopic removal of the kidney achieves equivalent disease control to open approaches.If the cancer outcome is the same, how then should use of these new procedures be determined? In this instance, secondary outcomes become important. For partial nephrectomy, major postoperative morbidity is not increased despite the longer and more complex surgical procedure.What about the advantages? Studies suggest that overall renal function, as measured by creatinine levels,...
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Rodger J. Winn is the Editor-in-Chief of JNCCN. His past positions include Associate Professor of Clinical Medicine at the University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.
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