Traditional Surgery: Removing All or Part of the Kidney
![Picture](/uploads/1/8/0/9/18096143/7980832.jpg?278)
Surgery may be the only treatment that is needed to treat kidney cancer.
Treatment of most kidney cancers begins with removal of the primary tumor in an operation called a nephrectomy. The purpose of surgery is to remove the primary tumor and involved tissue in the kidney. Even if cancer has already spread, a nephrectomy may still be beneficial because your body then has less cancer to fight through treatments that your doctors might recommend after surgery. In fact, a recent study of 245 patients with operable metastatic kidney cancer demonstrated that patients who had a nephrectomy before systemic therapy with interferon alfa had a higher survival rate than patients treated with interferon alfa alone.
A nephrectomy is a well-defined and common operation. Thousands of nephrectomies are performed every year for kidney cancer as well as for other diseases. Although it is a major surgery, the potential risks are well defined and it is usually quite safe if you do not have any underlying illnesses, such as heart disease or liver disease. Mortality rates are typically less than 1% for patients whose cancer has not metastasized and around 1% for patients with metastatic disease. Complications are not common unless the tumor is locally advanced, such as when the tumor extends into the renal vein or inferior vena cava (the large vein through which blood from your legs and internal organs returns to the heart), or the tumor has spread beyond the kidney. Extension of the tumor into the vein requires blood vessel surgery to remove the affected portion of the vein. This problem is well understood, but it prolongs the operation, and blood transfusions are often needed. Blood transfusions may not be required for smaller, localized tumors.
Though nephrectomy is the most common treatment for kidney cancer, it is important to note that in some cases it may not be appropriate. Your oncologist and/or urologist will explain the factors that influence the decision on whether to proceed with a nephrectomy.
There are several types of nephrectomies. The type depends mainly on the stage of the tumor. The doctor can explain each operation and discuss which is most suitable for the patient.
Treatment of most kidney cancers begins with removal of the primary tumor in an operation called a nephrectomy. The purpose of surgery is to remove the primary tumor and involved tissue in the kidney. Even if cancer has already spread, a nephrectomy may still be beneficial because your body then has less cancer to fight through treatments that your doctors might recommend after surgery. In fact, a recent study of 245 patients with operable metastatic kidney cancer demonstrated that patients who had a nephrectomy before systemic therapy with interferon alfa had a higher survival rate than patients treated with interferon alfa alone.
A nephrectomy is a well-defined and common operation. Thousands of nephrectomies are performed every year for kidney cancer as well as for other diseases. Although it is a major surgery, the potential risks are well defined and it is usually quite safe if you do not have any underlying illnesses, such as heart disease or liver disease. Mortality rates are typically less than 1% for patients whose cancer has not metastasized and around 1% for patients with metastatic disease. Complications are not common unless the tumor is locally advanced, such as when the tumor extends into the renal vein or inferior vena cava (the large vein through which blood from your legs and internal organs returns to the heart), or the tumor has spread beyond the kidney. Extension of the tumor into the vein requires blood vessel surgery to remove the affected portion of the vein. This problem is well understood, but it prolongs the operation, and blood transfusions are often needed. Blood transfusions may not be required for smaller, localized tumors.
Though nephrectomy is the most common treatment for kidney cancer, it is important to note that in some cases it may not be appropriate. Your oncologist and/or urologist will explain the factors that influence the decision on whether to proceed with a nephrectomy.
There are several types of nephrectomies. The type depends mainly on the stage of the tumor. The doctor can explain each operation and discuss which is most suitable for the patient.
![Picture](/uploads/1/8/0/9/18096143/8200475.jpg)
Radical nephrectomy:
Kidney cancer is usually treated with radical nephrectomy. The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area also may be removed.It may be appropriate to leave the adrenal gland behind, however, especially when the tumor is relatively small or located in the lower portion of the kidney.
![Picture](/uploads/1/8/0/9/18096143/2454290.jpg?314)
Simple nephrectomy: The surgeon removes only the kidney. Some people with Stage I kidney cancer may have a simple nephrectomy.
Partial nephrectomy:
The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the person has only one kidney, or when the cancer affects both kidneys. Also, a person with a small kidney tumor (less than 4 centimeters) may have this type of surgery. For more detailed information please click here
Partial nephrectomy:
The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the person has only one kidney, or when the cancer affects both kidneys. Also, a person with a small kidney tumor (less than 4 centimeters) may have this type of surgery. For more detailed information please click here
Partial or complete removal of the lymph nodes during surgery also may be helpful to determine if the tumor has spread, but again, this decision depends on a variety of factors. A pathologist will examine the lymph nodes under a microscope to see if any kidney cancer cells are present in the lymphatic system.
General complications include in nephrectomies:
- bleeding. This may require blood transfusion if the bleed is excessive.
- urine leak. This applies to partial nephrectomy surgery where the collecting system is opened during removal of the tumour. If not repaired in a water-tight fashion, urine can leak out through the kidney defect.
- numbness below the wound site. This is due to a cut nerve and is common in open surgery. It may take a few months to recover.
- bulge below the scar. This occurs with open surgery and is due to muscle weakness. It carries no consequence but may be unsightly.
![Picture](/uploads/1/8/0/9/18096143/5991487.jpg?295)
Laparoscopy and Kidney Cancer:
Open radical or partial nephrectomies – performed through a typical surgical incision — are the most common surgical techniques used to remove a diseased kidney. Recently, however, less invasive surgical techniques have been developed and are gaining increasing acceptance. These are now referred to as “minimally invasive surgeries,” and involve the use of a laparoscope, an instrument that is passed through a series of small incisions or “ports” in the abdominal wall. Laparoscopy, which is sometimes called “band-aid surgery,” can be used for both radical and partial nephrectomies and accomplishes the same things as traditional surgical techniques.
Laparoscopic radical or partial nephrectomy can result in decreased blood loss, a shorter hospital stay, less need for narcotic pain medication and shorter recovery time when compared with open radical nephrectomies.
Most medical centers and many surgeons offer laparoscopic radical nephrectomy. But the use of laparoscopic instrumentation can be technically difficult.Therefore, hand-assisted techniques have been developed to facilitate the procedure in select cases. Surgeons sometimes make a short incision in conjunction with the instrument ports in order to insert one hand to assist the laparoscopic maneuvers. Hand-assisted laparoscopy may make laparoscopic nephrectomies more widely available while maintaining the benefits of minimally invasive surgery.Laparoscopic partial nephrectomies can be done, too, but they are performed by a much more limited number of surgeons at the present time because of the technical expertise and experience required.
The laparoscope is a thin tube with an eyepiece at one end, and a light and a magnifying lens at the other. It’s put into the abdomen through a small cut in the skin. Generally two to three small cuts and one larger cut are needed for the operation. The larger cut is usually made close to the belly button and is used to remove the kidney.
Sometimes the surgeon may use a highly specialized machine to help with keyhole surgery. Instruments attached to the machine are controlled by the surgeon. This allows them to carry out very precise surgery and is sometimes called robotic surgery.
Open radical or partial nephrectomies – performed through a typical surgical incision — are the most common surgical techniques used to remove a diseased kidney. Recently, however, less invasive surgical techniques have been developed and are gaining increasing acceptance. These are now referred to as “minimally invasive surgeries,” and involve the use of a laparoscope, an instrument that is passed through a series of small incisions or “ports” in the abdominal wall. Laparoscopy, which is sometimes called “band-aid surgery,” can be used for both radical and partial nephrectomies and accomplishes the same things as traditional surgical techniques.
Laparoscopic radical or partial nephrectomy can result in decreased blood loss, a shorter hospital stay, less need for narcotic pain medication and shorter recovery time when compared with open radical nephrectomies.
Most medical centers and many surgeons offer laparoscopic radical nephrectomy. But the use of laparoscopic instrumentation can be technically difficult.Therefore, hand-assisted techniques have been developed to facilitate the procedure in select cases. Surgeons sometimes make a short incision in conjunction with the instrument ports in order to insert one hand to assist the laparoscopic maneuvers. Hand-assisted laparoscopy may make laparoscopic nephrectomies more widely available while maintaining the benefits of minimally invasive surgery.Laparoscopic partial nephrectomies can be done, too, but they are performed by a much more limited number of surgeons at the present time because of the technical expertise and experience required.
The laparoscope is a thin tube with an eyepiece at one end, and a light and a magnifying lens at the other. It’s put into the abdomen through a small cut in the skin. Generally two to three small cuts and one larger cut are needed for the operation. The larger cut is usually made close to the belly button and is used to remove the kidney.
Sometimes the surgeon may use a highly specialized machine to help with keyhole surgery. Instruments attached to the machine are controlled by the surgeon. This allows them to carry out very precise surgery and is sometimes called robotic surgery.
![](http://www.weebly.com/weebly/images/file_icons/pdf.png)
laparoscopic_nephrectomy.pdf | |
File Size: | 6608 kb |
File Type: |
Nephrectomy when the cancer has spread:
If the cancer has already spread to other places in the body (metastatic or secondary cancer), it may still be worth having the affected kidney removed. If the tumour in the kidney is causing symptoms such as pain or bleeding, or is affecting the balance of chemicals in your blood, taking it out may relieve this.
You may be given treatment with a targeted therapy or biological therapy drug to try to shrink the cancer. After this, it may be possible to have an operation to remove the kidney.
Although this operation won’t usually cure the cancer, it may help other treatments to work better and help to prolong your life.
However, these possible advantages need to be weighed up against the effects of having a major operation. Deciding whether to go ahead with an operation in these circumstances can be very difficult. It’s important that you discuss the benefits and disadvantages with your doctors when making up your mind.
Surgery to remove a secondary cancer:
Rarely, surgery may be used to remove a small secondary cancer in another part of the body, for example the lungs. This is very specialised surgery. It’s generally only possible if the cancer has spread to a limited area – usually just to one place in the body.
It’s also important that you’re fit enough to cope with the operation. Removing a secondary cancer may help to control the cancer for longer. Occasionally, it may be used to try to cure the cancer.
If the cancer has already spread to other places in the body (metastatic or secondary cancer), it may still be worth having the affected kidney removed. If the tumour in the kidney is causing symptoms such as pain or bleeding, or is affecting the balance of chemicals in your blood, taking it out may relieve this.
You may be given treatment with a targeted therapy or biological therapy drug to try to shrink the cancer. After this, it may be possible to have an operation to remove the kidney.
Although this operation won’t usually cure the cancer, it may help other treatments to work better and help to prolong your life.
However, these possible advantages need to be weighed up against the effects of having a major operation. Deciding whether to go ahead with an operation in these circumstances can be very difficult. It’s important that you discuss the benefits and disadvantages with your doctors when making up your mind.
Surgery to remove a secondary cancer:
Rarely, surgery may be used to remove a small secondary cancer in another part of the body, for example the lungs. This is very specialised surgery. It’s generally only possible if the cancer has spread to a limited area – usually just to one place in the body.
It’s also important that you’re fit enough to cope with the operation. Removing a secondary cancer may help to control the cancer for longer. Occasionally, it may be used to try to cure the cancer.