Used to be, when surgery was recommended for kidney cancer, surgeons would remove an entire kidney. Now research shows patients fare better 10 years after surgery if the operation removes just the tumors.
It makes for a trickier operation, but the kidney-sparing surgery gives patients a decreased risk of developing chronic kidney disease, according to an Upstate study published recently in the journal, Urologic Oncology.
Urology resident Michael Daugherty, MD, and his mentor, Gennady Bratslavsky, MD, analyzed a national database, concentrating on people between the ages of 20 and 44 who underwent surgery for small, localized kidney tumors. “We looked at these younger patients because we wanted to see what effects the surgery itself would have on the patient and their long-term outcomes. With the younger patients, they were assumed to have less underlying diseases, less chance of having hypertension or heart disease or things that would possibly cause them to have an earlier death.”
They compared cancer-specific survival and overall survival between those who had their kidney removed and those who just had the tumors removed. They found no difference in cancer-specific survival, “which means the surgical removal got rid of the cancer in both ways equally,” he says. In overall survival, however, “those treated with the entire removal of the kidney did worse at 10 years. Those that had the nephron-sparing surgery did better in the long term.”
Not all kidney cancers are treated with surgery. Many factors including the type of cells involved help doctors decide what to recommend. “These cancers may be very different in their sizes, their behaviors and their prognoses,” says Bratslavsky, who leads the department of urology at Upstate.
Some kidney cancers are hereditary, passed from parents to children through a defective gene. Some are not. Some are discovered incidentally, when a patient has a medical image for another reason, and a tumor is revealed on a kidney. Many are discovered only after a patient notices blood in his or her urine.
“Unfortunately when patients present with symptoms, the disease may be much more advanced,” says Bratslavsky.
Upstate physicians offer methods of destroying tumors without traditional surgery, and newer treatments that tap into the body’s own immune system to destroy cancer cells. “Active surveillance” is another important option when tumors that are slow growing or for patients for whom surgery would be too risky. Most of the surgeries for kidney cancer at Upstate are done laparoscopically, through tiny incisions, using robotic assistance.
No matter which type of cancer is diagnosed, Bratslavsky says, “it’s very important that patients with kidney tumors are managed in a setting where they can be provided with a multidisciplinary approach, such as at Upstate.” Radiologists, pathologists, medical oncologists, urologists and others come together in one room to discuss a particular patient’s options. This is where the question is asked, and answered: Which treatment, which surgery offers the patient the best outcome?
Read the study abstract in the journal, Urologic Oncology
Listen to the HealthLink on Air radio interview
Read Upstate’s Cancer Care publication