Our Summary

This research paper focuses on kidney cancer, specifically renal cell carcinoma (RCC), which makes up 3% of all adult solid tumors. Traditionally, a certain type of surgery (nephron-sparing surgery) was only done on patients with small kidney tumors, or patients who had a high risk of developing a tumor in their other kidney.

Nowadays, partial nephrectomy (PN), a type of kidney surgery, has become a standard method to treat small kidney tumors. This surgery has been shown to increase survival rates, maintain long-term kidney function, and reduce the need for dialysis or kidney transplants in patients with early-stage RCC.

Most kidney tumors are now found by chance during imaging tests like ultrasounds, CT scans, or MRIs. As a result, up to 40% of these tumors are detected when they are still small.

This paper reviews the use of open PN in treating small kidney tumors. It looks at when this approach is recommended, how successful it is at stopping cancer, and how it compares to other methods like laparoscopic (minimally invasive) and robotic PN.

Recent studies have shown that PN offers better survival rates, similar success in treating cancer, and a lower risk of severe chronic kidney disease compared to completely removing the kidney. This makes PN the preferred surgical method. However, laparoscopic and robot-assisted PN, when performed by experienced surgeons, can achieve similar results but may have a slightly higher complication rate.

FAQs

  1. What is the role of partial nephrectomy in the treatment of renal cell carcinoma?
  2. How does partial nephrectomy compare to laparoscopic and robotic techniques in treating small renal masses?
  3. What are the benefits of partial nephrectomy over radical nephrectomy in the treatment of T1a-staged RCCs?

Doctor’s Tip

One helpful tip a doctor might tell a patient about nephrectomy is to discuss the option of partial nephrectomy (PN) with their healthcare provider. PN has been shown to have better survival outcomes and preserve long-term renal function compared to radical nephrectomy. It is important for patients to understand all their treatment options and work with their healthcare team to determine the best approach for their individual case.

Suitable For

Patients who are typically recommended for nephrectomy include those with small renal masses detected in anatomically or functionally solitary kidney, multiple bilateral tumors, hereditary forms of RCC, and T1a-staged RCCs. Additionally, patients with incidentally detected kidney masses, smaller size masses, and those at risk of developing a tumor in the contralateral kidney may also be recommended for nephrectomy. Nephron-sparing surgery, particularly partial nephrectomy, is now considered the gold-standard surgical technique for the treatment of small renal masses, as it has been shown to be associated with better survival, long-term renal function preservation, and lower risk of severe chronic kidney disease compared to radical nephrectomy.

Timeline

Before nephrectomy:

  1. Patient is diagnosed with renal cell carcinoma (RCC) typically between the ages of 50 and 70.
  2. Imaging modalities such as ultrasound, computed tomography, or magnetic resonance are used to detect the kidney mass.
  3. Nephron-sparing surgery is considered for patients with small renal masses, anatomically or functionally solitary kidney, multiple bilateral tumors, or hereditary forms of RCC.
  4. Decision is made to proceed with partial nephrectomy (PN) based on the size and location of the tumor.

After nephrectomy:

  1. Patient undergoes open PN surgery to remove the kidney mass while preserving renal function.
  2. Oncological outcomes are monitored to ensure complete removal of the tumor.
  3. Long-term renal function is assessed to determine if dialysis or renal transplantation is needed.
  4. Studies show that PN is associated with better survival, oncologic equivalence, and lower risk of severe chronic kidney disease compared to radical nephrectomy.
  5. Laparoscopic and robotic PN techniques are also considered as alternatives, with experts achieving comparable outcome results.

What to Ask Your Doctor

  1. What are the reasons for recommending a nephrectomy instead of other treatment options?
  2. What are the potential risks and complications associated with nephrectomy?
  3. How will my kidney function be affected after the surgery?
  4. Will I need dialysis or a kidney transplant after the surgery?
  5. How long is the recovery period after a nephrectomy?
  6. Will I need to make any lifestyle changes after the surgery?
  7. What follow-up care will be needed after the surgery?
  8. Are there any alternatives to traditional nephrectomy, such as laparoscopic or robotic surgery?
  9. What is the success rate of nephrectomy in treating renal cell carcinoma?
  10. How often will I need to undergo imaging tests to monitor for any recurrence of cancer after the surgery?

Reference

Authors: Seveso M, Grizzi F, Bozzini G, Mandressi A, Guazzoni G, Taverna G. Journal: Int Urol Nephrol. 2015 Dec;47(12):1923-32. doi: 10.1007/s11255-015-1120-z. Epub 2015 Oct 5. PMID: 26438327