Surgery for Kidney Cancer

Surgery is the main treatment

for most kidney cancers.

The chances of surviving

kidney cancer without having

surgery are small.

 

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Laparoscopic nephrectomy and robotic-assisted laparoscopic nephrectomy: 

These newer approaches to the operation are done through several small incisions instead of one large one. If a radical nephrectomy is needed, many doctors and patients now prefer these approaches when they can be used. For a laparoscopic nephrectomy, special long instruments are inserted through the incisions, each of which is about 1/2-inch (1.27cm) long, to remove the kidney. One of the instruments, the laparoscope, is a long tube with a small video camera on the end.
This lets the surgeon see inside the abdomen. Usually, one of the incisions has to be made longer in order to remove the kidney (although it’s not as long as the incision for a standard nephrectomy).
A newer approach is to do the laparoscopic surgery remotely using a robotic system. The surgeon sits at a panel near the operating table and controls robotic arms to perform the operation. For the surgeon, the robotic system may provide more maneuverability and more precision when moving the instruments than standard laparoscopic surgery. But the most important factor in the success of either type of
laparoscopic surgery is the surgeon’s experience and skill. This is a difficult approach to learn. If you are considering this type of operation, be sure to find a surgeon with a lot of experience. 

 

The laparoscopic approach can be used to treat most renal tumors that cannot be treated with nephron-sparing surgery (see below). In experienced hands, the technique is as effective as a standard (open) radical nephrectomy and usually results in a shorter hospital stay, a faster recovery, and less pain after surgery. This approach may not be
an option for tumors larger than about 10 cm (4 inches) across or tumors that have grown into the renal vein or spread to lymph nodes around the kidney. 

 

Partial nephrectomy (nephron-sparing surgery)

In this procedure, the surgeon removes only the part of the kidney that contains cancer, leaving the rest of the kidney behind. As with a radical nephrectomy, the surgeon can make the incision in several places, depending on factors like the location of the tumor. Partial nephrectomy is now the preferred treatment for many people with early stage kidney cancer. It is often done to remove single small tumors (less than 4 cm across), and can also be done to remove larger tumors (up to 7 cm across). Studies have shown the long-term results to be about the same as when the whole kidney is removed. 
The obvious benefit is that the patient keeps more of their kidney function. A partial nephrectomy might not be an option if the tumor is in the middle of the kidney or is very large, if there is more than one tumor in the same kidney, or if the cancer has
spread to the lymph nodes or distant organs. Not all doctors can do this type of surgery. It should only be done by someone with a lot of experience.

 

Laparoscopic partial nephrectomy and robotic-assisted laparoscopic partial nephrectomy: Many doctors now do partial nephrectomies laparoscopically or using a robot (as described above). But again, this is a difficult operation, and it should only be done by a surgeon with a great deal of experience.

 

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