by Dr. C.H. Weaver M.D. updated 2/2019
According to a study published in the journal Cancer, researchers from the Urologic Institute at the Cleveland Clinic proposed that laparoscopic radical nephrectomy should become the standard of care for patients with early stage renal cancer.
Renal cell cancer is typically treated with one of two surgical options, depending on the extent of spread of disease: 1) surgery to remove the entire kidney, local lymph nodes, and any cancer in the area surrounding the kidney (radical nephrectomy); or 2) less aggressive surgery to remove only the part of the kidney affected with cancer (partial nephrectomy). Surgery is the standard treatment for RCC because the disease is typically resistant to radiation and chemotherapy.
Patients with stages T1 – T3 renal cell cancer have small cancers that are confined to the kidney and historically, patients with these early stage renal cell cancers underwent a radical nephrectomy through an extensive surgical procedure. The extensiveness of this procedure prohibited some elderly patients and/or patients with other medical complications from receiving optimal care.
Physicians have now adopted laparoscopic surgery as the a standard treatment. During the procedure, small, one-centimeter incisions are made in abdomen and side. Then, a very small tube that holds a video camera can be inserted through the incisions, creating a live picture of the inside of the patient’s body. This picture is continually displayed on a television screen, so that physicians can perform the entire surgery by watching the screen. Before the kidney containing the cancer is removed from the body, the incision through which it will be removed is enlarged to allow its passage with minimal contact.
Researchers initially evaluated the outcomes of 100 patients with renal cell cancer that underwent laparoscopic surgery at the Cleveland Clinic Foundation since August 1997. These patients had stage T1-T3a renal cell carcinoma with an average cancer width of 5.2 centimeters. The average surgical time was 2.8 hours and the average hospital stay was 1.6 days. Major complications occurred in only 3 patients. There were no deaths during surgery. All surgical specimens had no cancer detected in their outer margins. An average of 16 months following surgery, there were no local recurrences and only one death had occurred from distant cancer spread.
The analysis led to doctors from the Cleveland Clinic to adopt laparoscopic surgery as the standard of care for patients with early stage renal cell cancer. Because this procedure is effective and well tolerated, patients with early stage disease who would otherwise be excluded from undergoing a radical nephrectomy may now receive optimal treatment. Patients with early stage renal cell carcinoma should speak with their physician about the risks and benefits of undergoing a laparoscopic nephrectomy.
Laparoscopic surgery offers the benefits of a less invasive procedure but is also technically more difficult to perform. With the addition of robotic technology to laparoscopic surgery, certain limitations of laparoscopic surgery have been overcome and the surgical options for RCC continue to expand.
Both radical nephrectomy and partial nephrectomy may be conducted using laparoscopy. In the case of a radical nephrectomy, the incision is enlarged to allow passage of the kidney. With a partial nephrectomy, a small bulk of tissue is removed and the incision can remain small.
During a laparoscopic surgery for RCC, the surgeon makes small, one-centimeter incisions in the abdomen and side. The surgeon then inserts a very small tube that holds a video camera, which creates a live picture of the inside of the patient’s body. This picture is continually displayed on a television screen, so that surgeons can perform the entire surgery by watching the screen.
Cancer, Vol 92, Issue 7, pp 1843-1855, 2001