Kidney Cancer Surgery

When a patient is diagnosed with kidney cancer, how to remove the tumor surgically is one of the first options considered.  Like other cancers, detecting kidney cancer at an early, localized stage dramatically increases survival rates. “Luckily, the vast majority are small tumors,” says Thomas Schwaab, MD PhD, Urologist at Roswell Park Cancer Institute. (RPCI). “When those tumors are removed, and the margins are clear, the patient is cured.” Kidney cancer surgery may include:

• 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..
• Simple nephrectomy: The surgeon removes only the kidney. Some people with early kidney cancer may have a simple nephrectomy.
• Partial nephrectomy: The surgeon removes only the part of the kidney that contains the tumor and some of the tissue around it. A partial nephrectomy may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed.
• Nephroureterectomy: This surgery is similar to a radical nephrectomy but also includes the removal of the entire ureter and a small portion of the bladder.

What Happens During Surgery

During the nephrectomy, your doctor carefully examines all of the organs and tissue in the area of the kidney to make certain that there is no cancer located outside the gland. Your doctor may remove the lymph nodes in the region and have a pathologist examine them under a microscope to see if they have any cancer cells in them. In some situations it may be possible to remove the kidney, or part of it, using laparoscopic surgery. This involves surgery using a laparoscope (a thin, flexible tube with a light and magnifying lens at the tip) which enables the surgeon to look into the abdomen. The operation involves 2 small cuts made into the skin and muscle of the abdomen to allow the laparoscope and other instruments to be inserted. A larger cut, close to the belly button (navel), is needed to remove the kidney. This type of surgery gives a much smaller wound (incision).

Minimally-invasive surgery is our standard of care

At RPCI, the vast majority of kidney cancer surgeries are done laparoscopically, via three tiny “keyhole” incisions, resulting in less pain and blood loss and a shorter hospital stay and recovery period. Patients typically get discharged the day after surgery. RPCI surgeons have the experience and track record of a high-volume facility as well as technological innovations like the robotic daVinci Surgical System. This system to aid laparoscopic procedures involves robotic arms to manipulate tiny surgical instruments. The surgeon operates these arms and tools via a computer console and hand and foot controls while seeing a three-dimensional view of the surgical field magnified up to 15 times. The surgeon can operate these tools more precisely and with more steadiness than human hands. Robotic-assisted procedures allow surgeons to better recognize and control bleeding from small vessels, reducing blood loss. “The kidney is a highly vascularized organ and it tends to bleed a lot, explains Dr. Schwaab. “It’s easier to remove the entire kidney, but we want to retain better kidney function and do a partial nephrectomy whenever we can.”

RPCI surgeons have performed over 300 partial and 200 radical nephrectomies over the last five years, the highest volume of kidney cancer surgery and the highest volume of partial nephrectomy in Western New York.