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Treatments

There are a number of treatment options for kidney cancer; the ideal treatment depends on a number of factors, including the extent of the tumour and the current health of the patient. Treatment options vary and these should be discussed with the doctor to identify which is the best course of treatment for individual patients. They include surgery, chemotherapy and radiation therapy.

Radical Nephrectomy

The most common form of surgery for renal cell carcinoma (RCC), radical nephrectomy involves removal of the entire kidney, often along with the attached adrenal gland, surrounding fatty tissues and nearby lymph nodes (regional lymphadenectomy), depending upon how far the cancer has spread.

Partial Nephrectomy

It may be possible to remove only the cancerous tissue and part of the kidney if the tumour is small and confined to the very top or bottom of the kidney. A partial nephrectomy may be the procedure of choice for patients with RCC in both kidneys and for those who have only one functioning kidney. Partial nephrectomy may better preserve long term renal function compared to removing the entire kidney. This is certainly the case if a patient has other diseases that can affect kidney function in the future (such as diabetes), or if the opposite kidney is not working properly, has never formed or has already been removed.

Robotic and Laparoscopic Radical Nephrectomy and Partial Nephrectomy

Robotic and laparoscopic techniques allow the kidney to be removed using key-hole incisions in the abdomen. Occasionally 1 or 2 additional retraction ports may be required. Conversion to the standard open operation is easily accomplished, should technical difficulty be encountered.

Laparoscopic surgery uses hand-held key-hole instruments while the robotic surgery provides a 3-D magnified view with wristed instruments that are easier to move than standard hand-held key-hole instruments. A standard laparoscopic approach using the hand held keyhole instruments is sufficient for a radical nephrectomy. In comparison, a partial nephrectomy is much more complex and so using the robot can arguably help make the operation easier to perform.

A video on robotic surgery can be seen below. This video relates to a prostate operation. However, the robot can also be used for kidney surgery and the video demonstrates how the robot works.

Advantages of Robotic and Laparoscopic Surgery

The main advantage of robotics and laparoscopy are the reduction in pain and post-operative recovery time. Patients can usually mobilise unassisted two days post-op and are often ready for discharge at that time. Patients receiving the open operation usually cannot walk until day 4 or 5 and are not ready for discharge until a week or 10 days after surgery.

Most patients after robotic and laparoscopic kidney surgery are able to return to normal activities by the end of the first week, while patients after the open operation usually take 6 to 8 weeks. After a partial nephrectomy, patients should avoid strenuous physical activity for 12 weeks while the kidney heals.

Recent results from multi-centre trials have shown robotic and laparoscopic kidney surgery to be safe in the treatment of localised renal cancer, hence widening the indication for the operation.

Disadvantages of Laparoscopic Nephrectomy

This operation is technically demanding and is associated with a steep learning curve. The operating time is longer than open operation, although with experience this reduces significantly.

Problems associated with CO2 distension of the abdomen can cause problems such as shoulder pain, CO2 retention, possible embolisation and tumour spillage, which have not occurred in renal cell carcinoma.

Radiation Therapy

Radiation in the form of X-rays or other high-energy rays is used to shrink and kill cancer cells in some kidney cancer patients. The radiation is delivered as a focused beam (external beam radiotherapy) that is projected into the body through a linear accelerator.

Radiation therapy can be used as palliative therapy to lessen pain or bleeding in patients with inoperable or widespread metastatic RCC.

Follow-up Care and Recurrent Kidney Cancer

Some patients who undergo surgery to remove a cancerous kidney or kidney tumours experience a recurrence of the disease. For this reason, patients usually undergo a regimen of follow-up examinations after surgery. These include a complete physical examination, a chest X-ray, CT scans and ultrasounds, complete blood tests, and assessments of liver and kidney function. If the disease recurs but remains confined to a few small areas, additional surgery may be recommended. Radiation, biological, or chemotherapy also may be tried as an adjuvant or palliative (relief-giving) treatment.