New Surgery for kidney cancer Synonyms: renal cell cancer, renal cell carcinoma, kidney tumor, renal mass, hypernephroma, bilateral kidney cancer, bilateral renal cell cancer, bilateral renal cell carcinoma, bilateral kidney tumor, bilateral renal mass, bilateral hypernephroma, cancer of the kidney.
About Kidney Cancer
Two bean-shaped kidneys(one on each side of the lower back) work to cleanse the blood, help control blood pressure, and regulate the production of red blood cells. Renal cell cancer is the most common form of kidney cancer in adults. U.S. specialists diagnose about 35,000 new cases each year. Surgery is the recommended treatment for localized renal cell cancer. For patients who cannot undergo surgery, image-guided ablation may be an option. In adults, renal cell carcinoma (renal adenocarcinoma or hypernephroma) begins in the cells that line small tubes (tubules) in the kidneys. Children may develop a kidney cancer called Wilms' tumor.
For four decades doctors have removed the entire kidney when it was affected by a small tumor, but medical investigators in Manhattan said yesterday it's time doctors developed a new gold standard. Nearly 70 percent of people with kidney cancer develop only small tumors. In most of these cases, doctors remove the entire kidney. But a new analysis shows that removing only a small portion of the organ and the tumor is more beneficial.
The finding is a sea change in cancer surgery because most doctors believe that removing the entire organ is the best way to keep the disease at bay.
Dr. Paul Russo, a surgeon at Memorial Sloan-Kettering Cancer Center, found that removing the entire organ along with the tumor produces a dramatic decline in the patient's overall health. The remaining kidney is more likely to lose function when its twin is removed.
Moreover, if the patient has underlying heart disease, that too worsens. Alternatively, removing only a portion of the organ with the tumor affords the patient some remaining kidney function, Russo said. The analysis is in the current issue of the journal Lancet Oncology. "We are very proud of this work," Russo said, "because we think it's a crystallization and connects a lot of dots and provides a new sense of clarity."
His research demonstrated that when patients with two otherwise healthy kidneys underwent kidney-sparing surgery, they developed chronic kidney disease at a rate one-third that of patients whose entire organ was removed. Russo said the three-year probability of staying free of chronic kidney disease was 80 percent for those with a portion of the organ removed compared with 35 percent for those who underwent the radical procedure.
At most cancer centers in the country, such as his own, Russo said, doctors have been performing the less invasive procedure for years.
But Dr. Peter Scardino, chairman of the department of surgery at Sloan-Kettering, said surveys have shown a majority of patients treated for small kidney tumors have not benefited from the trend. He estimates that only one in 20 patients actually undergo the organ-preserving operation.
"The importance of this paper is that it documents, for the first time, the serious effects on kidney function and the high risk of chronic kidney disease when one kidney is fully removed for cancer," Scardino said.
Russo added that making the change to the less aggressive operation is a simple, common-sense approach. "This isn't about a new gadget that will save you. ... What we're doing is not about the gadgets, it's about preserving organ function."
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