Surgery for Kidney Cancer - Columbia Urology

Kidney Cancer - Surgery for Kidney Cancer

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Our Approach to Surgery for Kidney Cancer

At Columbia University Department of Urology at NewYork-Presbyterian Hospital our goal is to cure or treat each patient's disease with the fewest possible side effects while preserving as much kidney tissue as possible. We work closely together as a team to develop an individualized treatment approach for each patient. Our treatment plan is based on the size and stage of the cancer and the patient's age and general health.

Types of Surgery for Kidney Cancer

Kidney surgery is the main avenue of treatment for patients with cancer confined to the kidney. When surgeons remove only the tumor and leave the patient with a partial but healthy kidney, the procedure is called a partial nephrectomy. If the entire kidney must be removed the procedure is called a radical nephrectomy. Cryoablation of kidney tumors is another technique for destruction of the tumor while preserving the surrounding kidney. Using these techniques surgeons at Columbia Urology work to leave patients with as much healthy kidney tissue as possible without compromising the chance for a cure. If a patient's cancer has spread from the kidney to other organs, doctors are likely to treat it with targeted therapies, chemotherapy and/or immunotherapy.

Laparoscopic Partial or Radical Nephrectomy for Kidney Cancer

For most patients with kidney cancer confined to the kidney, doctors here will suggest a minimally invasive kidney surgery approach. Patients who undergo minimally invasive kidney surgery have significantly less pain, less blood loss, smaller incisions, a shorter hospital stay, and more rapid recovery when compared with open surgery.

Laparoscopic partial and radical nephrectomies are technically challenging kidney surgeries that are not performed at many medical centers. Dr. Jaime Landman at Columbia Urology is an internationally recognized expert in minimally invasive kidney surgery. He has performed more than 1,000 advanced laparoscopic kidney procedures, and is one of the most experienced surgeons in the world with this type of kidney surgery.

In a laparoscopic partial nephrectomy surgeons operate through three or four small incisions. They remove the tumor and a small margin of normal tissue around it, then repair or reconstruct the area of the kidney where the cancer was removed. Laparoscopic partial nephrectomy is a very effective procedure for treating small kidney tumors (less than 4 cm) that are not located at the center of the kidney. Tumors in the center of the kidney are often very close to the major blood vessels so in patients with a single kidney or with impaired renal function doctors may need to perform an open operation to remove only part of the kidney (a partial nephrectomy).

Patients with larger tumors (greater than 7cm) may need to have the entire kidney removed (a radical nephrectomy). Laparoscopic technology developed at Columbia Urology enables surgeons to remove the entire kidney through a small incision that doctors here can often make in a cosmetically acceptable location (along the bikini line, for example). This kidney surgery is similar to a laparoscopic partial nephrectomy.

Cryotherapy for Kidney Cancer

Cryotherapy treatment (also called cryoablation) is a promising new minimally invasive technique in which surgeons use very low temperatures to kill kidney cancer cells. Cryotherapy treatment is appropriate for small kidney tumors (less than 4 cm). During cryotherapy treatment surgeons insert several needles into the kidney tumor. Argon and helium gas circulate through the needles, lowering the temperature to -40°C for several minutes. Surgeons can control the extent of freezing and evaluate the kidney and needle placement with ultrasound imaging during the procedure. Depending upon the location of the tumor, doctors perform cryotherapy either through a laparoscopic or CT guided approach (which is done without incisions).

Open Partial or Radical Nephrectomy for Kidney Cancer

Patients with large and/or deep tumors, and who already have limited kidney function, are candidates for open partial or radical nephrectomy, in which the surgeons operate to remove part or the entire kidney through a single, long omit long incision in the flank. During partial nephrectomy, it is necessary to temporarily interrupt the blood supply to the kidney. Open surgery allows the kidney to be placed in ice and gives the surgeon more time to operate on the kidney since the ice reduces the oxygen consumption of the kidney. For this reason, complicated partial nephrectomies are preferentially performed by an open approach.

If a patient has a kidney tumor that involves the vena cava, the main vein leading into the heart, our urologists collaborate with NewYork-Presbyterian's heart surgeons to remove the cancer.