Kidney Cancer
Kidney cancers are the 12th leading cause of cancer death in the United States, and the 9th most common type of cancer.
What is Kidney Cancer?
Almost all of the kidney cancers in the U.S. are renal cell carcinomas (RCC), which grow from the lining of the small tubes in the kidney. In the current era, most renal masses are asymptomatic and small, and found by chance while performing imaging tests for other symptoms. But, if there are symptoms due to RCC, they will most likely be blood in the urine, flank or low back pain, weight loss, or a mass that is felt in the abdomen.
The presence of a kidney mass does not always mean there is cancer present. About 1 in 4 masses found in the kidney are benign, with no potential to spread. Smaller masses are more likely to be benign, while larger masses are more likely to be cancerous. A CT scan of the abdomen and pelvis are used to evaluate the extent of the tumor, and guide which treatment options may be best. Some tumors can be slow to grow while some can be aggressive. Aggressive tumors form, grow and spread very quickly.
Once a kidney mass is found, the common treatment options include active surveillance, ablation, or surgery with either partial kidney or complete kidney removal. The treatment plan will depend on:
- The size and location of the mass
- Your age and health
- Your preferences about side effects and treatment goals
- Results from other diagnostic tests such as renal mass biopsy if needed
Treatment Options:
Active surveillance is the least invasive management strategy for small, localized renal masses, and involves monitoring the tumor’s size and growth progression. Many patients never need treatment at all. This option is generally reserved for small tumors in more elderly patients.
Cryoablation or radiofrequency ablation (RFA) is another option that destroys the tumor with extreme cold or heat, respectively. These options are usually reserved for smaller tumors <3 cm in size, and located on the periphery of the kidney. While a viable treatment option especially in older patients, ablation has been shown to be slightly inferior for cancer control compared to surgical removal, and less durable over time.
Lastly, nephrectomy is a surgical procedure to remove all or part of the kidney. There are two types of nephrectomy for a tumor, either partial and radical. Partial nephrectomy (kidney-sparing surgery) removes a tumor or diseased portion on the kidney, while saving as much healthy, normal kidney as possible. By preserving the kidney, studies have shown post-operative kidney function is maximized, thus decreasing the risks of kidney failure in the future.
Traditionally, this surgery was performed through a large open flank incision, while needing to remove part of a rib. However, Dr. Yu uses the most cutting-edge robotic surgery techniques for partial nephrectomy including the da Vinci robotic platform and Firefly technology to minimize patient recovery. In addition, he uses various techniques, including retroperitoneoscopic approaches, selective vessel clamping, zero-ischemia (off clamp) and retroperitoneal lymph node dissections as needed to remove kidney tumors of all locations and stages. The robotic platform lends itself well to this surgery due to the kidney’s location, and the delicate dissection and sewing required. Since robotic-assisted surgery is minimally invasive, it typically results in less blood loss, less flank hernias, shorter hospital stay, less scarring and faster recovery for patients. Surgeries typically take 3 hours, and most patients are discharged 1 days after surgery with very little pain.
The robotic procedure is performed through 5-7 small abdominal incisions (1/2 inch each), which serve as ports through which the robotic arms are inserted. In patients with multiple abdominal surgeries or posteriorly located tumors, a retroperitoneoscopic approach may be undertaken which only requires 4-5 side and back incisions. The abdomen is then inflated with gas to create room to operate. Once the kidney is exposed, intraoperative ultrasound is used to identify the tumor and determine how wide of a margin is needed to completely resect the tumor. Blood flow to the kidney is then temporarily clamped off to prevent excessive bleeding when cutting out the tumor. After the tumor is removed, the kidney bed is delicately oversewn and repaired, and the blood flow is restored back to the kidney. Robotics provides a 3-dimensional and magnified view of the tumor and blood supply, which allows the surgeon to be more selective in the vessels that are clamped, thus minimizing the damage to the kidney. The wristed instruments also allow faster repair of the kidney after the tumor is removed, all translating into quicker recovery for the kidney. Patients who have very large tumors, or deep tumors next to the blood supply of the kidney may be better suited to undergo a radical nephrectomy or complete kidney removal. In addition, tumors that arise from the kidney collecting system (lining of the kidney drainage sac) are also treated with complete kidney removal and are not amenable to partial nephrectomy.
Dr. Yu has significant experience and expertise in robotic surgery to remove kidney tumors, for both partial or radical nephrectomy. Having completed fellowship training under Dr. Inderbir Gill, the world renowned expert in partial nephrectomy, Dr. Yu has performed hundreds of robotic partial nephrectomies, and may be able to offer partial nephrectomies even when other surgeons may recommend complete kidney removal. Currently, about 75-80% of all kidney tumor cases <7cm in size without evidence of vein or fat involvement are treated with robotic partial nephrectomy. Outcomes are the best in surgeons with extensive experience, and Dr. Yu has an excellent reputation for delivering excellent results with rare complications, while also being a strong communicator with an extraordinary bedside manner. Please schedule an appointment to have a detailed discussion regarding your case, and Dr. Yu will work with you to craft a treatment plan for your cancer that best fits you.
- 0% conversion to open surgery rate
- 0% positive margin rate for cancer left behind
- 0% conversion from intended partial to radical nephrectomy
- 95% patients stay one night in the hospital
At your visit, Dr. Yu will discuss with you about the preferred options to treat your kidney cancer.
Surgery FAQ
How will surgery affect my quality of life in the short-term and the long-term?
Your quality of life immediately after surgery will be impacted temporarily as you recuperate from surgery. Even though your nephrectomy (either partial or radical) will be performed robotically, it will still require a small incision to remove the tumor (partial nephrectomy) or a slightly larger incision to remove the entire kidney (radical nephrectomy). As a consequence, you will have some minor pain and will need to avoid some activities for 6 weeks. You may also have some constipation and gas cramps during the immediate postoperative period. It is unlikely that this surgery will have significant long term effects on your quality of life, especially if a partial nephrectomy is performed.
What are the risks and possible complications of surgery?
The risks of surgery in general include the risks of anesthesia. People who have general anesthesia can experience complications such as myocardial infarction (heart attack), stroke or even very rarely death. These are very rare complications of anesthesia. There is also a small risk of bleeding requiring blood transfusion during a partial nephrectomy. This risk is lower if the entire kidney were to be removed. Other uncommon risks of this surgery include infection, urine leakage from the kidney, damage to adjacent tissues/organs, and hernia formation from one of the small incisions. Depending on your kidney function prior to surgery and the amount of kidney tissue that is removed, there is a small chance of renal failure requiring dialysis. Overall, the risk of any of these complications is low.
What new information will we learn about my cancer after this surgery?
Once the kidney mass or entire kidney is removed, it will be examined by a physician specialist known as a pathologist. The pathologist will examine the tissue using a microscope. The pathologist will then be able to determine if the kidney mass is actually a kidney cancer, the aggressiveness of the cancer, as well as the extent of the cancer, including whether or not it has spread outside of the kidney surface. Occasionally we will remove lymph nodes with a partial or radical nephrectomy, and the pathologist can determine if there is any spread of the kidney tumor to any of the local lymph nodes.
What tests do I need to do before surgery?
You will need to have blood tests before surgery that include a complete blood count, a metabolic panel, tests of bleeding function, and a type-and-screen for the possibility of a blood transfusion. You will also need a urinalysis to confirm that there is no urinary tract infection. If you are over 55 years old, you will also require an electrocardiogram and a chest x-ray.
At your visit, Dr. Yu will discuss with you about the preferred options to treat your kidney cancer.
Dr. Yu was very thorough in explaining the procedure and I knew beforehand what I would go through with the cancer operation. He visited with me twice a day while I was in the hospital. My surgery was very complicated and he was very successful in removing all the cancerous tissue. I am very pleased with the care I received from Dr. Yu. Great doctor.
– Anonymous
Dr. Yu is exactly what I want in a doctor. He is very straight forward, giving me the information I need to make decisions on my healthcare. Dr. Yu told me what he determined to be the best course of action to treat my cancer. I agreed, and he performed a complete nephrectomy.
– Anonymous
Dr. Yu and his team went above and beyond with their service to me. I am truly grateful that he and his team were there for my difficult kidney removal. I will never forget his dedication to my case and recommend him for his excellent urologic care and skill set with robotic surgery.
– Patrick H.
I had a very complicated surgery to remove a cancerous tumor in my kidney. I was told by several doctors that Dr Yu is considered to be the best in this country at this surgery. He is a fantastic doctor with a fantastic bedside manner.
– Karyn N.
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