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Cancer

Specialized 'Kidney-Sparing' Procedures Give Cancer Patients More Options

In the past, a kidney cancer diagnosis almost always meant losing a kidney, leaving the patient with one functioning kidney and an increased risk of needing dialysis in the future. But that is no longer the case, with what is known as "kidney-sparing surgery" to remove small cancerous tumors without sacrificing the entire organ, using minimally invasive techniques.

Kidneys are small, crescent-shaped organs that filter blood and remove waste products from the body via urine. People can live with one or part of one kidney, but if both organs are removed or dysfunctional the blood must be mechanically cleansed using a process known as dialysis.

Clinical data has shown that removing only the tumor and sparing the rest of the kidney is as effective as removing the entire organ in certain patients.

Minimally Invasive Procedures

A number of kidney-sparing, minimally invasive surgical procedures are offered for the treatment of small kidney tumors, including:

Minimally invasive laparoscopic surgery is a technique for operating inside the abdomen that requires only very small incisions versus a single, large incision. The surgeon performs the operation through small ports using a fiber-optic light source, camera and specialized instruments. The magnification provided by the camera (laparoscope) allows for improved visualization and increased precision during surgery. Patients also report faster recovery and less pain after minimally invasive surgery.

The goal is to maintain the kidney's function so the patients have more options if the cancer recurs or if they develop any form of kidney disease later. Once the tumor is removed, the kidney can heal and usually maintains function.

Kidney-sparing surgery is usually performed for tumors that are 4 centimeters in diameter or smaller (about the size of a walnut) but can be done for larger tumors in special circumstances such as patients with decreased overall kidney function or those who have only one functioning kidney.

Partial nephrectomy is a good option for younger patients with small kidney tumors who are otherwise healthy and can tolerate a significant operation. Ablation is generally a better option for patients who are older or cannot tolerate traditional surgery due to other medical conditions.

Cryoablation involves inserting a needle into the center of the kidney tumor and subjecting it to extreme cold (negative 40 degrees Fahrenheit) to destroy the cancerous tissue and cells. The dead tumor tissue is left in place. After the procedure, the patient has regular imaging tests to monitor for cancer recurrence.

Radiofrequency Ablation (RFA) is performed in a similar manner to cryoablation and involves inserting a needle into the tumor. The difference is that the tumor cells are destroyed using localized heat delivered through the needle, instead of freezing the tumor.

Though preliminary data with renal tumor ablation favors cryoablation, both these ablation procedures are still relatively new, and long term data on cancer recurrence is limited. These procedures are generally recommended for a select group of patients and can be performed either laparoscopically (with ‘keyhole’ surgery) or percutaneously (by inserting the needle through the skin).

The use of robotic (daVinci) surgery for performing these minimally invasive kidney procedures is also being evaluated.

According to the National Cancer Institute, more than 54,000 people will be diagnosed with kidney cancer in 2008. Approximately 13,000 will die from the disease.

This article originally appeared in UC Health Line (4/10/08), a service of the University of Cincinnati Academic Health Center Public Relations Department and was adapted for use on NetWellness with permission, 2006.

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Last Reviewed: Apr 22, 2008

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati