The past ten years have witnessed a wave of innovative surgical solutions for the remedy of kidney cancer. The majority of these procedures involve what's known as a nephrectomy: a surgery during which a cancerous kidney and its ureter are either partly or wholly removed, along with surrounding tissue in some cases. There are four types of nephrectomy: partial, simple, radical, and bilateral, which have traditionally been performed using open surgical techniques (which involve large incisions and are quite invasive). These procedures are explained below.
Partial nephrectomy has become the treatment choice for removing localized cancer allowing for most of the kidney to be preserved. This procedure is used infrequently, as the cancer must not have spread to other parts of the kidney muscle and tissue. Over the last 10 years we have been able to refine techniques in partial nephrectomy that have allowed for broader indications. There is ample scientific evidence to now show that survival is equivalent between partial nephrectomy and radical nephrectomy as long as negative margins can be maintained. Kidney function can be maximally preserved with Dr. Scherr's success in complex partial nephrectomy operations.
Some renal tumors may not be suitable for treatment by partial nephrectomy because of their position or size. Additionally, some renal tumors extend into the renal vein or inferior vena cava (IVC) and can even extend up into the heart. Radical nephrectomy is the preferred treatment option when the cancer has reached this point. During a radical nephrectomy, all of one kidney is removed with the adjacent adrenal gland as well as neighboring lymph nodes. Dr. Scherr has the largest experience in New York and one of the largest in the world in removing aggressive kidney tumors that have extended into the heart. He works closely with cardiothoracic surgeons at New York Presbyterian Hospital and success has been second to none.
Minimally Invasive Laparoscopic Nephrectomy
During a laparoscopic nephrectomy, a series of small keyhole incisions (about the size of a dime) will be made in a patient's abdomen, enabling the insertion of instruments and a miniature camera. The camera is attached to a monitor that provides a picture of the operative field. Typically, patients who've undergone laparoscopic nephrectomy spend 1-2 days in the hospital before being discharged, compared to an average of 5 days after a typical open kidney removal surgery.
Unfortunately, not every kidney cancer patient can undergo laparoscopic nephrectomy. Several radiological tests will be required to ascertain whether or not laparoscopic nephrectomy is an option. Of course, even patients who don't qualify can still undergo a conventional radical or partial nephrectomy. Using individualized medical consultation, Dr. Scherr will recommend the best approach to maximize your chances for a durable cure.
- Requires four half-inch incisions in the abdomen, plus one 2.5 to 3 inch abdominal incision.
- No muscle is cut during any of the incisions.
- 1 to 2 day hospital stay after surgery.
- Less post surgical scarring and less discomfort and a decreased need for pain medication.
- 2 to 3 weeks post operative recovery time before returning to normal, but non-taxing, activity level.
Open Surgical Nephrectomy
- It will require between an 8 to 12 inch musculature incision on the side of the abdomen. No ribs are removed.
- 2-3 day post operative hospital stay.
- Possible 6-8 weeks of recovery time before you can return to normal, but non-taxing, activity level.
- There will be more post surgical scarring and pronounced need for pain medication.
Of course, there are a variety of alternate treatment options available to patients, from high-energy radiation, cryotherapy, focused ultrasound to chemical chemotherapy, that can be applied to kidney cancers; depending on your circumstances and based upon individual discussions and testing. We have identified novel markers that now enable us to determine the type of kidney cancer preoperatively and therefore better able to tailor therapy according to exact pathological diagnosis.