Surgery to Treat Kidney Cancer
Surgery is the standard treatment for RCC. There are several surgical options, depending on the stage of the disease and the overall health of the patient.
Prior to surgery, most patients undergo an electrocardiogram (ECG or EKG), chest x-ray, complete blood count (CBC), and electrolyte profile with BUN and creatinine. Imaging tests (e.g., CT scan, intravenous pyelogram [IVP], MRI scan) are performed to determine the exact location of the kidneys and to detect anatomic variations (e.g., duplicated ureter, horseshoe kidneys), kidney stones, and cancer of the bladder, ureter, or other kidney.
When the tumor is small and confined to the top or bottom portion of the kidney, a partial nephrectomy (removal of part of the kidney) may be performed. This procedure also may be used to treat patients with RCC in both kidneys and patients who have only one functioning kidney.
Radical nephrectomy is the most common treatment for RCC. This procedure, which is performed under general anesthesia, involves removal of the entire kidney and the adrenal gland. It also may include removal of surrounding tissue and nearby lymph nodes (regional lymphadenectomy), depending on how far the cancer has spread.
Radical nephrectomy may be performed through a large abdominal incision (open radical nephrectomy) or 4 or 5 smaller incisions (laparoscopic radical nephrectomy). In laparoscopic radical nephrectomy, an instrument consisting of a light and camera lens that produces magnified images (called a laparoscope) is used to allow the physician to see inside the abdomen.
Tiny instruments are inserted through the incisions and used to separate the kidney from surrounding structures (e.g., ureter, blood vessels). The physician then enlarges one of the incisions and removes the kidney. Laparoscopic radical nephrectomy takes slightly longer to perform than open surgery.
Generally, the risk for complications and blood loss during surgery is similar in both procedures. Patients who undergo laparoscopic nephrectomy may require less pain medication, usually are discharged from the hospital sooner, and often are able to resume normal activities earlier.
Complications of nephrectomy include the following:
- Damage to surround organs (e.g., spleen, pancreas, large or small intestine) and blood vessels (e.g., aorta, vena cava)
- Failure of the remaining kidney
- Hemorrhage (excessive bleeding) during or after surgery
- Incisional hernia (protrusion of organs or tissue through the abdominal wall)
- Pneumothorax (air in the chest cavity, outside the lungs)
Arterial embolization may be used in patients who are unable to undergo surgery (e.g., patients with severe heart disease). In this procedure, a catheter (thin tube) is introduced into the artery in the groin that supplies blood to the cancerous kidney. A small piece of material (e.g., gelatin sponge) is then inserted into the catheter to cut off the blood supply, destroying the tumor and the organ. If the patient is able to undergo surgery at a later date, the kidney is removed.
Kidney Cancer Postoperative Prognosis
Renal cell cancer is the second most common tumor type to undergo spontaneous regression following removal of the primary lesion; this occurs in about 0.5 percent of cases. Once metastasis occurs, prognosis depends on the extent of the spread and the interval between kidney removal and the appearance of metastases. Overall, the 5-year survival rate for RCC—all stages combined—is about 40-45 percent.