Kidney Cancer Surgery: Open, Laparoscopic and Robotic Methods

Kidney cancer (kidney tumor) is a malignant disease of the kidney that often occurs in adults. Renal cell carcinoma (RCC) is also known as renal cell cancer. It is more common in men, and its incidence increases after the age of 50. These are cancers that are resistant to radiotherapy (radiation therapy) and chemotherapy. The most effective treatment is surgery, that is, surgery.

Kidney cancer is usually diagnosed by radiological methods (Ultrasound, tomography, MRI), but in very special cases, kidney biopsy is required. Kidney cancer is resistant to chemotherapy and radiotherapy, the most effective treatment is surgery. In this regard, patients diagnosed with kidney cancer should follow the doctor’s advice without wasting too much time and undergo surgery as soon as possible.

Which surgery will be performed on which patient is decided as a result of the doctor’s evaluation. Urologist experienced in kidney cancer surgery informs the patient in advance about the method by which radical or partial nephrectomy will be performed.

Symptoms and treatment methods vary depending on the stage of the disease. With the advancement of technology, kidney surgeries, which were previously performed with open methods, are now performed with laparoscopic and robotic methods. For more information about kidney cancer, you can check our articles on our website.

What are the Kidney Cancer Surgery Methods?

The most effective treatment for kidney cancer is surgery, that is, surgery. In addition to the classical open surgery for the surgery of this disease, laparoscopic and robotic methods have also begun to be used with the advancement of technology. Different surgical methods are used depending on the stages. The most commonly used surgical methods in the treatment of kidney cancer are:

• Open renal radical nephrectomy
• Laparoscopic radical nephrectomy
• Robotic radical nephrectomy

How many types of surgeries are there for kidney cancer?

The type of surgery to be performed in kidney cancer varies depending on the stage and size of the disease. There are two main types of surgery methods:

• Radical nephrectomy: Radical nephrectomy means removing the entire kidney. In this surgery, the kidney, along with the fatty tissue around the kidney and the membrane surrounding the kidney (Gerota’s fascia), the upper half of the urinary tract (ureter) coming out of the kidney, the tumor in the upper part of the kidney, the adrenal gland on the same side and the surrounding lymph nodes are removed as a whole. However, if the kidney cancer is far from the adrenal gland, there is no need to remove the adrenal gland. Radical nephrectomy surgery can be performed by open, laparoscopic and robotic methods depending on the condition of the disease.
• Partial nephrectomy: With this method, not the entire kidney is removed, but only the cancerous part along with a few millimeters of healthy tissue around it. There are some criteria for this surgery, it may not be suitable for every patient. If the cancer is very large, has several foci, is located in the inner part of the kidney, has reached the main vessels of the kidney (artery, vein), or has reached the collecting parts of the kidney (calyces and renal pelvis), partial nephrectomy is not suitable in these cases, and it may be necessary to remove the entire kidney. Partial nephrectomy surgery can be performed open, laparoscopic and robotically.

Anesthesia Type, Surgery Duration and Hospital Stay

General anesthesia is applied in kidney surgeries. Surgeries may take 2-3 hours depending on the size of the cancer and its spread to surrounding organs. After the surgery, patients stay in the hospital for 2-3 days.

Pre-Surgery Preparation

Since kidney tumor surgery will be performed under general anesthesia, patients must prepare accordingly. The following points should be taken into consideration when evaluating patients before surgery:

• If patients are using blood thinners such as aspirin before surgery, they must be stopped 5-6 days in advance.
• Patients continue to take their hypertension, heart and diabetes medications.
• Before the surgery, relevant examinations are performed to determine whether there is any obstacle to surgery such as lung or heart disease.
• General blood tests are performed.
• If necessary, blood is adjusted in case of bleeding.
• Patients stop eating and drinking 5-6 hours before the surgery and are admitted to the hospital.
• If the cancer involves large vessels, the surgery must be performed in a cardiovascular surgery unit.
• If the cancer has involved neighboring organs, consultation is requested from the relevant department for support during the surgery, if necessary.
• The informed consent form is read to the patient and his/her approval is obtained.

What Should Be Considered After Surgery?

Post-operative care is very important. Intensive care may be required due to the course of the surgery, the age of the patient, and those with additional cardiovascular disease. In general, the following are the points to be considered after kidney cancer surgery:

• Patients do not take anything by mouth for 4-5 hours after surgery and are fed intravenously.
• Painkillers and prophylactic antibiotics are started against pain.
• Depending on the course of the surgery, patients may stay in intensive care if necessary.
• Patients can drink oral fluids 4-5 hours after surgery
• Patients begin to walk slowly after 5-6 hours
• If everything goes well, patients are discharged after 2-3 days
• Oral painkillers and antibiotics are given after surgery
• It is recommended that patients do not do heavy work or do sports for 2-3 weeks after the surgery.

Are open and closed surgeries medically superior to each other?

Open, laparoscopic, and robotic kidney cancer treatments do not have any medical advantage over each other. In other words, there is no difference between the life expectancy of patients and the recurrence rates of the disease after open, laparoscopic and robotic radical and partial nephrectomy surgeries.

Today, thanks to the advancement of technology, most kidney surgeries are now performed by closed methods. Closed methods are also examined in two main groups. These are laparoscopic methods and robotic methods. Robotic methods are more expensive than laparoscopic and open surgery methods, but they have some advantages over open surgery.

Which method is used in which situations?

The method of surgery to be performed on patients diagnosed with kidney tumors is decided after a detailed evaluation of the patient. Finally, surgery is performed openly, laparoscopically, or robotically.

Conditions for open kidney surgery:

• If the kidney cancer is very large: Generally, the open method is preferred for sizes up to 10 cm.
• If kidney cancer is advanced and involves neighboring organs (liver, spleen, kidneys, large vessels), it is more appropriate to perform open surgery for these patients.
• Patients who have had previous kidney surgery
• Those who have had previous abdominal surgery
• Patients who cannot undergo laparoscopic and robotic surgery due to economic reasons
• Surgeon’s experience

 Situations where robotic and laparoscopic kidney surgery will be performed:

• Kidney cancer is not very large and has not affected surrounding organs.
• Patients who have not had kidney surgery before
• Patients who have not had abdominal surgery before
• If the patient’s financial situation is suitable
• If the technical facilities to perform the surgery are available
• If the surgeon has experience in this field and the appropriate team

What are the disadvantages of open surgery?

Radical and partial nephrectomy surgeries performed with open surgery have some disadvantages compared to robotic and partial methods.

• Bleeding may be more
• Surgical incision (scar) may be larger
• Wound healing may take a longer time
• Patients may stay in hospital longer after surgery
• Pain may be greater after surgery
• It may take longer for patients to start their normal lives
• It is an advantage that it is lower in cost compared to robotic and laparoscopic surgeries.

What are the advantages of robotic and laparoscopic kidney cancer surgeries?

In recent years, kidney cancer surgeries have been performed using less invasive methods such as laparoscopic and robotic methods. These techniques have some important advantages over classical open surgery. We can list them as follows;

• Bleeding is less
• The surgical incision is smaller
• Wound healing occurs in a shorter time
• Hospital stay is shorter than open surgery
• Postoperative pain is less
• Patients start their daily lives earlier
• It is a disadvantage that the cost is higher compared to open surgery (robotic surgery is more costly).

In Summary: Kidney cancers are cancers that are resistant to chemotherapy (drug therapy) and radiotherapy (radiation therapy). So chemotherapy and radiotherapy are not very effective against these cancers. Today, the most effective method in the treatment of kidney cancer is surgery, that is, surgical removal of the cancerous kidney. The earlier the disease is detected, the higher the life expectancy of patients after surgery and the lower the recurrence rate. In this regard, in order to get a better result in kidney cancer, patients should be detected in the early stages (period) as possible.

There are no tumor markers used in the early diagnosis of kidney cancer and in monitoring recurrences after treatment. These cancers are detected accidentally by examinations such as ultrasonography and tomography during the investigation of other diseases or are detected during regular check-ups of conscious patients. In patients diagnosed with bone pain, bleeding and an abdominal mass, the disease is usually advanced.

Radical nephrectomy is usually performed by open or laparoscopic method. The robotic method is not preferred because it is costly and cannot be performed everywhere. Partial nephrectomy is usually performed by closed methods (robotic, laparoscopic). We have long had experience in open, robotic and laparoscopic kidney surgery, and we successfully perform appropriate methods for our patients. Our results are consistent with the international literature.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY

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