On February 2nd 2016, Fadi N. Joudi, MD, FACS published in The Wichita Eagle –
Finding of a kidney mass is a common reason for patients to be referred to a urologist. This often provokes angst among patients as they wonder about the significance of this diagnosis. Is it cancerous? If so, has the cancer spread to other organs?
Equally worrisome are their concerns about how the tumor will be treated if it is cancerous. Will the urologist have to remove the whole kidney and if so, can he or she do so in a minimally invasive approach? Will this affect my kidney function?
Fortunately, there is good news for these patients. Research indicates that removing only part of the kidney (partial nephrectomy) is about as effective at controlling cancer as removing the whole kidney (total nephrectomy). And, saving part of the kidney helps avoid renal function decline.
With the advancement in robotic surgery, including improved 3-D magnification and accuracy of laparoscopic instruments, partial nephrectomy is less invasive than it was in years past, resulting in a shorter hospital stay, and quicker recovery.
To ease the anxiety associated with kidney cancer, it’s helpful to understand more about the disease and how it’s treated.
Kidney cancer is among the 10 most common cancers in men and women in the United States, with approximately 62,000 new cases and 14,000 deaths annually. The cancer occurs twice as frequently in men than it does in women and average age at diagnosis is 64.
Risk factors for kidney cancer include:
- Having kidney cysts while being on dialysis for kidney failure
Rarely is it due to a genetic disease or running in families.
Symptoms may include:
- Blood in the urine
- Flank pain
- Feeling a mass in the abdomen
Most patients are diagnosed when the kidney tumor is incidentally detected on a CT (computerized tomography) scan, ultrasound or MRI (magnetic resonance imaging) performed for other reasons. For example, while undergoing tests to rule out a kidney stone, or evaluating the gallbladder or the source of back pain.
Eighty-five percent of kidney tumors are malignant (cancerous). Sometimes the urologist may not be able to discern whether it’s cancerous until the tumor is removed.
After the patient is evaluated to make sure they do not have disease elsewhere, as kidney cancer can spread to lymph nodes or distant organs such as the lung, standard treatment is surgery to remove the tumor.
Until recently, total nephrectomy was the traditional approach. However, in the last two decades, partial nephrectomy has proven to have similar results with the added benefit of helping to retain kidney function. Kidney tumors that are found incidentally tend to be smaller and more likely to be amenable to partial nephrectomy.
Performing a partial nephrectomy is prudent in patients with just one kidney, diabetic patients, and patients who already have compromised kidney function. The urologist surgically removes only the part of the kidney that is involved with tumor and then precisely reconstructs the healthy part of the kidney.
Partial nephrectomy is a technically more advanced procedure than total nephrectomy as the urologist has to take several steps to make sure the tumor can be safely removed. Partial nephrectomy can be done with a single big incision (open approach) or laparoscopically (small keyhole incisions) with robotic assistance.
Occasionally, partial nephrectomy may not be feasible due to the location of the tumor or if the tumor is very large in size. However, patients can rest assured that removing part of the kidney is possible in most situations, and advances in urologic robotic surgery have made the procedures more desirable.