Years ago, when a person presented with a renal mass, the standard approach was a nephrectomy — removing the entire kidney. While effective in removing cancer, having one kidney may cause dysfunction leading to long-term dialysis. Over time, treatment evolved to preserving kidney function with partial nephrectomy. We remove the tumor while sparing the rest of the organ so the patient retains their kidney. Initially, open surgery was the only way to do this, but we now use minimally invasive robotic surgery. In Wisconsin, we are leaders in offering partial nephrectomies. This approach offers our patients better outcomes and better quality of life.
Partial nephrectomy is a surgical procedure in which only a portion of a kidney is removed. This treatment removes the tumor while leaving much of the kidney intact and preserving normal kidney function.
- Robotic/laparoscopic partial nephrectomy: For some patients, surgeons can remove part of the kidney using minimally invasive, small-incision techniques. In some instances, laparoscopic partial nephrectomy can be performed with the assistance of robotic tools such as the da Vinci® Surgical System. In addition to saving part of the kidney, the advantages of a minimally-invasive partial nephrectomy include a shorter hospital stay (patients typically go home the next day), less postoperative pain and a return to normal activities faster.
- Open partial nephrectomy: For larger tumors and more complex cases, surgeons perform a traditional open surgery to remove a portion of the kidney.
In rare cases, total removal of the affected kidney may be necessary. Patients with adequate kidney function can generally tolerate the loss of one kidney. Over the long term, these patients are at a slightly increased risk of needing dialysis. For patients who suffer from diabetes, high blood pressure or cardiovascular disease, radical nephrectomy can increase the risk of kidney failure.
Patients who require a radical nephrectomy usually suffer from advanced kidney cancer or very large kidney tumors. Radical nephrectomy can be performed either as a laparoscopic procedure or a traditional open surgery, depending on the patient’s individual situation.
Patients with very large kidney tumors can benefit from a pre-surgical procedure to cut off the blood supply to the tumor. Using minimally invasive techniques, an interventional radiologist injects a vessel-blocking substance into the main kidney artery. This procedure can make the nephrectomy surgery safer and faster by reducing surgical blood loss.
Treatment for Tumor Thrombus
In a small number of patients, a kidney tumor may invade major veins nearby. This condition is called tumor thrombus. Depending on how extensive they are, tumor thrombi can require complex treatment. An embolization procedure will often be performed to shrink the tumor before surgery. In some cases, a vascular surgeon must remove the tumor from within the blood vessel, and surgical reconstruction of a vein may be required.
Tumor thrombi can sometimes grow all the way up to the heart, in which case a cardiac surgeon may need to perform a bypass. Occasionally, treatment of a thrombus will require the liver to be temporarily moved out of the way. In these instances, transplant specialists are part of the surgical team.
Surgical Outcomes for Kidney Cancer Patients
Most people are diagnosed with localized disease — it has not metastasized to the lymph nodes, lungs or other areas. Typically, they have excellent outcomes, including a 90% chance of being cancer-free long term.