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Surgery is the main treatment for most renal cell carcinomas. The
chances of surviving a renal cell cancer without having surgery are
small. Depending on the stage and location of the cancer and other
factors, surgery may be used to remove either the cancer along with
some of the surrounding kidney tissue, or the entire kidney. The
adrenal gland (the small gland that sits on top of each kidney) and
fatty tissue around the kidney may be removed as well.
Radical Nephrectomy
The most common operation to treat renal cell cancer is called
a radical nephrectomy. In this operation, the
surgeon removes your whole kidney, the attached adrenal gland, and the
fatty tissue around the kidney. (Most people do just fine with only the
one remaining kidney.)
The surgeon can make the incision in several places. The most
common sites are the middle of the abdomen (belly), under the ribs on
the same side as the cancer, or even in the back, just behind the
cancerous kidney. Each has its advantages in treating cancers of
different sizes and in different locations in the kidney.
Laparoscopic Nephrectomy
This approach to radical nephrectomy has quickly become, for
some doctors, a preferred method for removing kidney tumors.
The operation is done through several small incisions (which
is why it is sometimes called "keyhole" surgery) as opposed to one
large one. Special long instruments are inserted through the incisions,
each of which is about 1/2-inch long, to perform the operation. One of
the instruments has a small video camera on the end, which allows the
surgeon to see inside the abdomen. Usually, one of the incisions has to
be made longer in order to remove the kidney (although it's not as long
as the incision for a standard nephrectomy).
This approach can be used to treat most renal tumors that
cannot be treated with nephron-sparing surgery (see below). The
technique is thought to be as effective as open radical nephrectomy and
usually involves shorter hospital stay, a faster recovery, and less
pain after surgery.
Regional Lymphadenectomy (Lymph
Node Dissection)
This procedure involves removing nearby lymph nodes to see if
they contain cancer. Many doctors do this along with the radical
nephrectomy, although not all doctors agree that it is necessary. The
main reason for doing it is to try to more accurately stage the cancer
by determining if it has reached the lymph nodes (instead of relying
only on imaging study results). This can be important for predicting
chances for survival and deciding on further treatment options. In
theory, removing the lymph nodes might also increase the chances that
all of the cancer is removed, but this has not been proven.
Partial Nephrectomy
(Nephron-Sparing Surgery)
In this procedure, the surgeon removes only the part of the
kidney containing cancer, leaving the rest of the organ behind. As with
a radical nephrectomy, the surgeon can make the incision in several
places, depending on factors like the location of the tumor.
This approach is used most often when there is a need to
preserve some of the remaining kidney function, such as in people with
cancer in both kidneys, those who only have one kidney and develop
cancer in that kidney, or in people who already have reduced kidney
function for some other reason. It may also be used to try to preserve
as much kidney function as possible in people who are more likely to
develop other kidney cancers in the future, such as those with von
Hippel-Lindau disease.
A partial nephrectomy may also be done in patients with a
single kidney cancer that is smaller than 4 cm (about 1¾ inch) across.
Studies have shown the long-term results to be about the same as for
removing the whole kidney. The obvious benefit is that you retain more
of your kidney function. Partial nephrectomies are generally not done
for larger tumors, if there is more than one tumor in the same kidney,
or if the cancer has spread to the lymph nodes or distant organs.
Some doctors at major medical centers are now studying whether
laparoscopic partial nephrectomy is a possible option. But it is a
difficult operation to do, and it is generally thought of as an
investigational procedure at this time.
Removal of Metastases
About 1 out of 4 patients with renal cell carcinoma will
already have metastatic spread of their cancer when they are diagnosed.
In some cases, surgery may still be helpful.
Attempts at
curative surgery: In rare cases where there is only one
metastasis or if there are only a few that can be removed easily
without causing serious side effects, surgery may lead to long-term
survival in some people. This may be done at the same time as a radical
nephrectomy or at a later time if the cancer recurs (comes back).
Surgery to
relieve symptoms (palliative surgery): In cases where
other treatments aren't helpful, surgically removing the metastases can
sometimes relieve pain and other symptoms, although this usually does
not help patients live longer.
Risks of Surgery
Risks with surgery include:
- bleeding during surgery or after surgery that may require
blood transfusions
- wound infection
- damage to internal organs and blood vessels (such as the
spleen, pancreas, aorta, vena cava, large or small bowel) during
surgery
- pneumothorax (unwanted air in the chest cavity)
- incisional hernia (bulging of internal organs near the
surgical incision due to problems with wound healing)
- kidney failure (if the remaining kidney fails to function
well)
Other Local Therapies
Whenever possible, surgery is the main treatment for kidney
cancers that can be removed. But for people who are too sick to have
surgery, other approaches can sometimes be used to destroy kidney
tumors. While they may be helpful for some people, there is much less
data on their long-term effectiveness than there is for surgery, and
some doctors may still consider them to be experimental.
Cryotherapy (Cryoablation)
This approach uses extreme cold to destroy the tumor. A hollow
probe (needle) is inserted into the tumor either through the skin
(percutaneously) or during laparoscopic surgery. Very cold gases are
passed through the probe, creating an ice ball that destroys the tumor.
To be sure the tumor is destroyed without too much damage to nearby
tissues, the doctor carefully watches images of the tumor during the
procedure (with ultrasound or other tests).
The type of anesthesia used for cryotherapy depends on how it
is being done. Possible side effects include bleeding and damage to the
kidneys or other nearby organs.
Radiofrequency Ablation (RFA)
This technique uses high-energy radio waves to heat the tumor.
A thin, needle-like probe is placed through the skin and advanced until
the end is in the tumor. Placement of the probe is guided by ultrasound
or CT scans. Once it is in place, an electric current is passed through
the probe, which heats the tumor and destroys the cancer cells.
RFA is usually done as an outpatient procedure, using local
anesthesia (numbing medicine) where the probe is inserted. You may be
given medicine to help you relax as well. Major complications are
uncommon, but they can include bleeding or excessive tissue damage.
Arterial Embolization
This technique is used to block the artery that feeds the
kidney with the tumor. A small catheter (tube) is placed in an artery
in the inner thigh and is advanced until it reaches the artery going
from the aorta to the kidney (renal artery). Material is then injected
into the artery to block it, cutting off the kidney's blood supply,
causing it (and the tumor) to die. Although this procedure is rarely
performed, it is sometimes done before nephrectomy to reduce bleeding
during the operation. Last Revised: 10/22/2007
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