With many surgical options available to treat patients with kidney cancer, it is important for patients to make informed discussions with the care team to understand what approach may be best for a patient’s disease type and stage.
According to the American Cancer Society, surgery is the most common treatment for patients with kidney cancer, and most people with early-stage disease (meaning stages 1, 2 and 3) can be cured with this approach. The primary goal of kidney cancer surgery is to remove or treat the cancer effectively while preserving kidney function and providing the best possible outcome and quality of life for the patient.
There are several different types of surgeries for kidney cancer, each with its specific indications and appropriateness based on the stage and characteristics of the cancer. Here are the main surgical options and when they are typically considered appropriate:
Partial Nephrectomy (Nephron-Sparing Surgery)
This type of surgery is appropriate for small to medium-sized tumors (T1 and some T2 tumors) that are confined to a specific area of the kidney. In addition, it is suitable when the tumor is in a location that allows for the preservation of kidney function.
It is the preferred option when the patient has only one kidney or has pre-existing kidney disease.
Radical Nephrectomy
Compared with a partial nephrectomy, a radical nephrectomy, which is when the entire kidney is removed, is appropriate for larger tumors that have grown beyond the kidney’s boundaries or when the cancer has invaded nearby structures.
This is recommended when the tumor is large, the kidney function is already compromised or there is evidence of cancer spreading outside the kidney.
Laparoscopic or Robotic-Assisted Surgery
These approaches are suitable for small- to medium-sized tumors (T1 and some T2 tumors) that are confined to the kidney and haven’t spread to other organs. They are also preferred for patients who desire a less invasive approach, smaller scars, reduced postoperative pain and quicker recovery compared to open surgery.
With laparoscopic surgery, the surgeon makes a few small incisions (usually three to four) in the abdomen, and a thin tube called a laparoscope, equipped with a camera and light source, is inserted through one of the incisions. Other tools are inserted through the other incisions, allowing the surgeon the manipulate and remove the tumor.
Of note, robotic-assisted surgery is similar to laparoscopic surgery to uses robotic technology to enhance the surgeon’s precision and control.
These approaches may not be suitable for large tumors or those with complex locations that require more extensive surgical access.
Cryotherapy and Radiofrequency Ablation
This procedure is appropriate for small kidney tumors (T1a tumors) that are localized and haven’t spread outside the kidney. In particular, it is suitable for patients who may not be eligible for traditional surgery due to medical conditions or poor overall health.
Cryotherapy, also known as cryoablation, is a minimally invasive procedure used to treat kidney cancer by freezing and destroying cancerous cells within the kidney. In contrast, radiofrequency ablation uses heat to destroy cancer cells within the kidney.
These approaches may not be recommended for large tumors or tumors in critical areas where preserving kidney function is essential.
Embolization
This is often used as a pre-surgery treatment to shrink larger tumors and reduce blood loss during surgery and is appropriate when the tumor is too large for other treatments or when surgery alone may cause excessive bleeding. It can also be used as a palliative treatment to alleviate symptoms caused by larger tumors, even if the cancer cannot be completely removed.
With embolization, the surgeon blocks the blood supply to the tumor, which reduces the tumor’s blood flow and causes it to shrink, potentially alleviating symptoms.
Nephrectomy with Inferior Vena Cava Thrombectomy
This complex surgical approach is appropriate when the cancer has extended into the large vein that carries blood from the lower body to the heart. It is often considered for patients with advanced kidney cancer who require removal of the kidney and the tumor thrombus within the vein.
It is important to note that the appropriateness of each surgical option depends on the individual patient’s condition, the stage of the cancer, the location and size of the tumor, and the overall health of the patient. Treatment decisions should be made after a thorough evaluation by a multidisciplinary team, including urologists, oncologists and other specialists.
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