The Doctor Is In

Keep your kidneys—A new approach to cancer treatment

by Amar Singh, MD

Kidneys work hard to regulate your body fluid, including the water in your eyes and electrolytes in your blood. But when kidney cancer is detected, traditional cancer treatment meant kissing your kidney goodbye.

With approximately 52,000 Americans diagnosed with kidney cancer last year, resulting in nearly 12,000 deaths, kidney cancer is no lightweight.

The traditional treatment for kidney cancer is the removal of the entire kidney, including any cancerous or non-cancerous masses. This surgical procedure, known as a radical nephrectomy, has been the standard approach to treating kidney cancer since its development in 1969.

But modern technology and minimally invasive surgical techniques are now providing many kidney cancer patients at Erlanger with another option: minimally invasive kidney-sparing cancer surgery, also known as a partial nephrectomy. With this approach, only the cancerous mass is removed, and the kidney is spared.

Symptoms may be silent

The classic symptoms of kidney cancer are flank pain and blood in the urine. Although nearly 71% of people who are diagnosed with a kidney mass have no symptoms, those who have symptoms may experience flank pain and blood in their urine.

Kidney cancer is initially diagnosed as a mass or lump in the kidney, which is often discovered during routine imaging tests, such as ultrasounds, cat scans, or MRIs, for other health concerns. Approximately 23% of these kidney masses are benign, meaning they are not cancerous. The majority are smaller than 7 centimeters, also known as T1 stage.

A different approach

Many recent studies make a strong case for kidney-sparing cancer surgery, as compared to a complete kidney removal. According to these studies, benign masses are discovered in about one out of four complete kidney removals. Since current imaging and biopsy techniques cannot accurately distinguish between a cancerous and benign mass, removal of the complete kidney often occurs even though the mass is noncancerous.

New evidence has also shown that the removal of the entire kidney does not offer additional advantages for cancer control, as compared to removing only the tumor. Moreover, the radical surgical procedure often increases the risks of kidney failure and dialysis with the loss of an entire kidney, especially for individuals with certain medical conditions, such as obesity, hypertension, or diabetes.

Kidney-sparing surgery

Kidney-sparing cancer surgery has become the standard of care at all major urological cancer centers. Traditional kidney-sparing cancer surgery involves making a large cut on the side and removing the tumor and a small amount of normal kidney tissue around the tumor while leaving rest of the kidney in place. Many clinical studies have confirmed the safety and cancer cure of this procedure. While this approach gives patients similar cancer cure rates as the total kidney removal, it does not increase the risk of developing kidney failure and needing dialysis in the future.

Smaller is better The surgical approach for kidney-sparing cancer surgery has taken another giant step in recent years. Modernization in laparoscopic surgical tools, development of better laparoscopic ultrasound equipment, and the more recent development of robotic surgical technology allow patients to undergo successful kidney-sparing cancer operations using minimally invasive approaches.

With laparoscopic or robotic surgery, the entire minimally invasive operation is performed through three to four small incisions (approximately 1/3 inch) on the abdomen. Only the masses or tumors are removed without removing the entire kidney.

Laparoscopic magnification and robotic instruments, along with the laparoscopic ultrasound, map the kidney mass precisely and in great detail.

Then these masses are cut out, removed, and analyzed by a pathologist. The remaining kidney is reconstructed and left in place.

Compared to traditional, open operations with large incisions, patients undergoing minimally invasive procedures have less pain, smaller scars, and a shorter recovery period. Most patients go home in one to two days instead of spending almost a week in the hospital after undergoing traditional open surgery.

Amar Singh, MD, urologist, practices with Academic Urologists at Erlanger. He is also Chief of Urological Oncology at Erlanger. For more information, call Erlanger’s physician referral line at 423-778-LINK(5465).