Renal Cell Carcinoma
Kidney cancer is a malignant disease of the kidney frequently seen in adults. Renal cell carcinoma (RCC) is also known as renal cell carcinoma. 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.
The diagnosis of kidney cancer is usually made by radiological methods (ultrasound, tomography, MR), kidney biopsy is required in very special cases. 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 much time and surgery should be performed as soon as possible.
Which surgery will be performed on which patient is decided as a result of the doctor’s evaluation. The urologist, who is experienced in kidney cancer surgery, informs the patient in advance about which method to perform radical or partial nephrectomy.
Symptoms and treatment methods vary according to the stage of the disease. With the advancement of technology, kidney surgeries that 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 in our site.
What Are The Surgical Methods In The Treatment Of Kidney Cancer?
There are two main types of surgery in kidney cancer. Which surgery will be suitable for the patient is decided by the doctor as a result of a detailed evaluation.
- Radical nephrectomy
- Partial nephrectomy
Radical nephrectomy means removal of the entire kidney. In this surgery, along with the kidney, the fatty tissue around the kidney and the membrane surrounding the kidney (Gerota’s fascia), the upper half of the urinary canal (ureter) coming out of the kidney and the adrenal gland on the same side of the kidney and the surrounding palpable 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 can be performed with open, laparoscopic and robotic methods depending on the condition of the disease.
With this method, not the entire kidney is removed, but only a few millimeters of healthy tissue around the cancerous part. There are some criteria for this surgery, it may not be suitable for every patient. If the cancer is very large, in several foci, localized in the inner part of the kidney, has reached the main vessels of the kidney (arteries, veins), has reached the renal collecting parts (calyces and renal pelvis), partial nephrectomy is not appropriate in these cases, it may be necessary to remove the entire kidney.
Parsiyel nefrektomi ameliyatı açık, laparoskopik ve robotik olarak yapılabilir
- If patients use blood thinners such as aspirin before surgery, they must be discontinued 5-6 days in advance.
- Patients continue to take their hypertension, heart and diabetes medications.
- Before the operation, relevant examinations are performed to reveal whether there is an obstacle to the operation, such as lung or heart disease.
- General blood tests are done.
- If necessary, blood is adjusted for the possibility of bleeding.
- Patients stop eating and drinking 5-6 hours before the surgery and are hospitalized.
- Informed consent form is read to the patient and approval is obtained.
What Should Be Considered After The Operation?
- Patients do not take anything by mouth for 4-5 hours after surgery, they are fed intravenously.
- Painkillers and prophylactic antibiotics are started against pain and infection.
- Depending on the course of the surgery, patients can stay in the intensive care unit if necessary.
- Patients can take liquids by mouth 4-5 hours after the surgery.
- Patients start walking 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
Types Of Anesthesia, Operation Time and Hospital Stay
General anesthesia is used in kidney surgeries. The operations may take 2-3 hours depending on the size of the cancer and its spread to the surrounding organs. After the surgery, patients stay in the hospital for 2-3 days.
Are Open And Closed Surgeries Medically Superior To Each Other?
Open, laparoscopic, robotic treatment of kidney cancer has no medical advantage over each other. In other words, there is no difference between the survival rates and recurrence rates of the patients after radical and partial nephrectomy operations performed with open, laparoscopic and robotic methods.
Today, thanks to the advancement of technology, most of the kidney surgeries are now performed with closed methods. Closed methods are also examined in two main groups. These are laparoscopic methods and robotic methods. Robotic methods are more expensive in terms of cost compared to laparoscopic and open surgery methods, but they have some advantages over open surgery.
Kidney Cancer Surgery Methods
- Open kidney radical nephrectomy
- Laparoscopic radical nephrectomy
- Robotic radical nephrectomy
Open Kidney Cancer Surgery Has Some Disadvantages
Radical and partial nephrectomy operations performed with open surgery have some disadvantages compared to robotic and partial methods.
- Bleeding may be more
- The surgical incision (scar) may be more
- Wound healing may take longer
- Patients can stay in hospital longer after surgery
- Post-operative pain may be more
- It may take longer for patients to start their normal lives
- Cost is lower than robotic and laparoscopic surgeries
Advantages Of Robotic And Partial Kidney Cancer Surgeries
- Bleeding is less
- The surgical incision is smaller
- Wound healing takes a shorter time
- Hospital stay is shorter than open surgery
- Post-operative pain is less
- Patients start their daily lives earlier
- Cost is higher than open surgery (robotic surgery is more costly)
Which Method Is Used In Which Cases?
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 has advanced and has affected neighboring organs (liver, spleen, kidneys, great vessels), open surgery is more appropriate 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 for economic reasons
Conditions for robotic and laparoscopic kidney surgery:
- Kidney cancer is not very large, if the surrounding organs are not involved
- Patients who have not had previous kidney surgery
- Patients who have not had previous abdominal surgery
Kidney cancers are cancers that are resistant to chemotherapy (drug therapy) and radiotherapy (radiation therapy). In other words, chemotherapy and radiotherapy are not very effective against these cancers. Today, the most effective method in the treatment of kidney cancers is surgery, that is, surgical removal of the cancerous kidney. The earlier the disease is caught, the higher the survival time of the 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 caught as early as possible (period).
There are no tumor markers (markers) used in the early diagnosis of kidney cancers and in the follow-up of recurrences (recurrence) after treatment. These cancers are detected by chance during the investigation of other diseases, by means of tests such as ultrasonography and tomography, or are detected during regular check-ups of conscious patients. In patients with bone pain, bleeding and a mass in the abdomen, the disease usually means advanced.
Radical nephrectomy is usually performed by open or laparoscopic method, which is not preferred because the robotic method is costly and cannot be performed anywhere. Partial nephrectomy is usually performed with closed methods (robotic, laparoscopic). We have had enough experience in kidney surgery with open, robotic, laparoscopic and laparoscopic methods for a long time and we have been successfully performing the appropriate methods for our patients. Our results are compatible with the international literature.
Prof. Dr. Emin ÖZBEK
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