Kidney Cancer Treatment
There are some cases where the appropriate course of action is not to operate. For selected patients with small early cancers, the Comprehensive Kidney Cancer Program team may recommend active surveillance because if a tumor is indolent (or slow-growing), it might not require treatment. Active surveillance is an especially a good option if there are other factors, for example if the the patient is older or has other health problems that mean he or she is not a good candidate for surgery. Active surveillance is different than “watchful waiting”, however. Patients are seen on a regular schedule to monitor and assess their condition.
Partial nephrectomy refers to the surgical removal of cancerous kidney tissue while leaving the healthy kidney intact. A partial nephrectomy can be performed robotically, laparoscopically, or open. The robotic procedure takes less time, helping to ensure the ischemia time (time kidney is without blood flow) is short enough to prevent damage to the kidney. Additionally, the robotic procedure results in less blood loss, less operative time and a faster recovery in most cases. Dr. Badani's team has published results that show the blood transfusion and infections rates are lowest, and the ability to spare healthy kidney remains the highest. Partial nephrectomy is the preferred approach if possible, based on individual and tumor characteristics.
If a kidney tumor is large or located close to the main kidney artery or vein, a partial nephrectomy to just remove the tumor may not be feasible in the most experienced hands. In these cases, the surgeon will perform a radical nephrectomy for the complete removal of the cancerous kidney. Fortunately, if the patient’s other kidney is healthy; there is minimal impact on his or her quality of life or lifestyle. A radical nephrectomy is performed only if a partial nephrectomy is deemed not safe or possible after reviewing all imaging and even a final check using 3D ultrasound during the operation itself.
For patients who are not surgical candidates (too ill for surgery, older, or whose tumor is very small), tumors can sometimes be destroyed using cold or heat. These procedures are relatively quick, preserve healthy tissue, and do not involve a large incision (if done percutaneously --- through the skin). As the data is limited on long term results for cancer control, long term imaging surveillance and/or biopsies may be required subsequent to this procedure.
Cryoablation: freezing the tumor using needles inserted through small incisions. Dr. Badani’s research has found that cryobalation is equally effective to partial nephrectomy for treatment of small kidney cortical tumors when followed up in the short term. Dr. Badani and colleagues also found that use of a standard needle core biopsy technique before laparoscopic cyroablation for small renal cortical tumors (freezing the tumors through small surgical incisions) resulted in the most accurate tumor diagnosis. Increased biopsy accuracy was also found when the patients were younger and had larger tumors.)
Robotic Kidney Surgery
425 West 59th Street
New York, New York 10019
Department of Urology
5 East 98th Street, 6th Floor
New York, New York 10029