Treatments for Kidney Cancer
Renal Cell Carcinoma (Kidney Cancer) is a surgical disease. For most patients with a renal tumor or mass, surgery of some form is recommended.
A radical nephrectomy is when the entire kidney (including the tumor) is removed. This can be done via an open incision across the side of the abdomen or laparoscopically, through small keyhole sized incisions. The chance for cure is high with this surgery, depending on the tumor size and stage. When done through an open approach, hospitalization and recovery time are longer. Performing this laparoscopically minimizes recovery and hospital stay with equivalent cancer control rates.
A partial nephrectomy is when the tumor and just a small rim of normal kidney tissue (called the margin) are removed. This procedure has become the new gold standard in most kidney tumor surgeries. This is because of studies that have shown an overall survival benefit to leaving the patient with some normal kidney on that side. Complications such as kidney failure and high blood pressure are minimized. We also know that when performed correctly, a partial nephrectomy results in an equal chance of cure as that of a radical nephrectomy. Not all tumors are amenable to a partial nephrectomy-this depends on their size, location in the kidney, and experience of the surgeon. A partial nephrectomy can be performed via an open incision, laparoscopically or with robotic assistance. If the open procedure is chosen, an incision is made on the abdomen and the hospital stay and recovery are similar to that of an open radical nephrectomy. If a laparoscopic procedure is selected, small keyhole incisions are made, and the recovery time, hospital stay and blood loss are typically less. The problem with this type of procedure is that the laparoscopic instruments do not lend themselves to the complex movements needed to remove a kidney tumor and sew the kidney back together.
The da Vinci robot is another option for both partial and radical nephrectomy. This advanced surgical instrument lends itself particularly well to these procedures, as the technology allows the surgeon to remove complex tumors and sew the remaining kidney back together, all through only 5 to 6 small keyhole incisions. The surgeon is not limited by technology, as occurs with the laparoscopic approach. The robotic surgeons at CUC perform robotic partial nephrectomy when it is determined to be the best treatment plan. Dr. Troy has been at the forefront of pioneering a specific technique, referred to as clamp less zero-ischemia robotic partial nephrectomy. This technique is currently used by Drs Troy, Keuer and Lodowsky when performing robotic partial nephrectomies.
In select cases, tumor ablation may be performed. This treatment option consists of either freezing the tumors to very low temperatures or heating the tumors to very high temperatures. While less invasive then a radical or partial nephrectomy-(sometimes a hospital stay is not even needed), the primary disadvantage to this treatment is that because the tumor is not removed, it is difficult to know that the cancer has actually been destroyed. Recurrence rates are much higher than with partial or radical nephrectomy. Additionally, patients require more frequent imaging studies to monitor for cancer recurrence.
Active surveillance is a newer approach in which a small kidney tumor is monitored for signs of growth or progression. We know that most kidney tumors grow very slowly and may take a long time to spread (metastasize). For an older patient, who may be too sick to undergo a surgical procedure, this approach may be preferred. Active Surveillance requires imaging tests every 6-12 months and blood work annually. If there are signs of tumor growth or progression, immediate treatment is often recommended. Until we have better tests to predict which tumors will progress and which will not, this approach carries some risk.