What is the surgical treatment of kidney cancer
Surgery is the main treatment for most cases of kidney cancer and can often cure it. Depending on the stage and location of the tumor, it can be done to completely remove the affected organ (radical nephrectomy) or to remove just the tumor and a safety margin around it (partial nephrectomy). In some situations, the adrenal gland (a small organ located on top of each kidney), the fatty tissue around the kidney, and the lymph nodes in that area are also removed.
Some patients whose cancer has spread to other organs may benefit from surgery, as it can help reduce the symptoms of the disease, such as pain and bleeding.
Types of surgery for kidney cancer
Surgeries performed for kidney cancer include different procedures, the main one being nephrectomy. The following are the different types of nephrectomy:
- Radical nephrectomy – the kidney, adrenal gland, lymph nodes in the region and the fatty tissue around the organ are completely removed. The incision for this surgery can be made in several places, the most common being the center of the abdomen, below the ribs (on the same side where the tumor is located) or in the back, behind the kidney. Importantly, most people who have one of their kidneys removed maintain a good quality of life;
- Laparoscopic nephrectomy – special surgical instruments are inserted through small incisions made in the skin. One, the laparoscope, is a long tube with a small camera attached to one end, allowing the surgeon to see inside the abdomen. Usually, one of the incisions is a little larger, as it is through this that the kidney will be removed;
- Robot-assisted laparoscopic nephrectomy – this approach uses a robotic system that performs the laparoscopic surgery remotely. The surgeon stands in front of a panel next to the operating table and controls the robotic arms that perform the operation from there. Robotic surgery allows the surgeon to move instruments more easily and accurately compared to traditional laparoscopic surgery. The advantages of this technique are: faster recovery, shorter hospital stay and less pain after surgery. However, it may not be an option for tumors larger than 7 cm, for those that have grown into the renal vein and have spread to the lymph nodes located around the kidney; and
- Partial nephrectomy (nephron-sparing surgery) – only the part of the kidney affected by the tumor is removed. It is usually the treatment of choice for patients with early-stage kidney cancer or to remove small tumors, although it can also be done in patients up to 7 cm. One of its main advantages is that the patient maintains part of the renal function.
Some cases of kidney cancer may require regional lymphadenectomy, in which lymph nodes near the kidney are removed to check for a tumor. This procedure can be done in conjunction with radical nephrectomy, and the amount of lymph nodes removed depends on the characteristics of the tumor, suggesting whether or not it has a high risk of spreading.
Most doctors agree that lymph nodes should be removed if they appear enlarged on imaging tests or are abnormal during the operation. They can also be removed to help determine what stage the cancer is at.
In case of kidney cancer metastasis, which occurs in one in three individuals with the disease, surgery on affected organs may also be indicated. And when there is no possibility of a cure, palliative surgery is done to relieve pain and other associated symptoms.
Possible adverse effects of kidney cancer surgery
Short-term risks of surgeries performed to treat kidney cancer include reactions to anesthesia, bleeding, possible damage to nearby organs and veins (such as spleen, pancreas, aorta and vena cava, large and small intestine), clots and infections. The presence of post-surgical pain is also common, but it is managed with analgesic medications.
Other complications that may occur include pneumothorax (presence of air in the chest cavity), incisional hernia (occurring at the surgical scar site), leakage of urine into the abdomen (after partial nephrectomy) and renal failure (when the other kidney is not able to function properly).
Although people can live well with only one kidney, some long-term complications can arise, such as high blood pressure and chronic kidney disease.
It is important to highlight that each patient reacts in a different way, and factors such as type, size and location of the tumor, in addition to the surgical technique used, can contribute to the results.