Taking A Little To Get A Lot in Kidney Cancer Surgery

2011-04-13 | |
Last updated: 2011-04-13
Getting Better Kidney Cancer Surgery Outcomes

For the treatment of cancer, both chemotherapy and radiation therapy provide powerful tools in the battle against the disease. Despite the value of these approaches, however, some cancers do not respond well to either treatment, meaning that surgery becomes one of the few remaining options to eliminate cancerous tissue. Renal or Kidney Cancer is one such form of the disease that is typically treated with surgery.

While surgical approaches are the most effective means to treat Kidney Cancer, not all forms of surgery are equivalent. In many cases, the type of surgery being used is outdated or inappropriate for the severity of the cancer being treated. Undergoing a poorly suited surgery can have negative effects on recovery time and health. As a result, patients with the disease must be aware of their options and must push to ensure that their treatment uses the most appropriate surgical technique.

In spite of kidney cancer not being one of the most common cancers, it is still a disease that affects a significant number of people. Falling into the ten most common cancers in the US, the cancer affects roughly 60000 people per year and kills more than 1 in 5 individuals affected. Worldwide, more than 200,000 cases of Kidney Cancer occur each year and roughly 50% of those who develop the disease will die. Roughly 3% of all solid tumors are from Kidney Cancer and men are at greater risk for the disease than women.

Although these numbers are not large in comparison to other cancers, the rate of Kidney Cancer deaths is increasing and the medical community does not understand the reason. The rate of death for those diagnosed with this cancer increased by more than 250% between the early 1980s and the early 2000s. This is despite an increase in the ability to detect such tumors and an increase in the number of surgeries to save lives. At this time, the average rate of increase in the number of people affected by the disease is between 2% and 3% per year.

For patients who are diagnosed with Kidney Cancer, survival rates are typically above 90% when the disease is found early. Unfortunately, in many situations, few symptoms occur until the cancer has progressed significantly. Like any other cancer, once the cancer has spread, treatment becomes more difficult. As well, complications from some surgery can mean a significant reduction in the patient’s quality of life.

One of the most common forms of surgery for Kidney Cancer is the nephrectomy or removal of the kidney. While this surgery does ensure removal of the cancerous tissue, it is heavy handed in the majority of cases. Unfortunately in the US and Canada, 80% of Kidney Cancer surgeries remove the entire kidney.

This is not good for patients given that researchers from the University of Alberta have found that the odds of complications are significantly higher. In fact, their research has found that the risk of complications is almost 80% higher for patients who have the entire kidney removed as compare to those patients who only had a portion of the organ extracted. The complications include chronic kidney disease and kidney failure, both of which are extremely serious on their own.

Furthermore, in research from the Cleveland Clinic, scientists studying the results of kidney removal in more than 500 patients found that in those patients over the age of 75, removing a kidney did not improve the life expectancy of these individuals. In fact, the kidney removal increased the risks of dying from cardiovascular disease and accelerated the rate at which the other kidney developed problems. In short, this treatment for Kidney Cancer was as bad for patient health as the cancer itself.

So, with full kidney removal being undesirable, the next best option becomes a partial nephrectomy or removal of a part of the kidney. As well, doing such surgery using laparoscopic or minimally invasive keyhole techniques minimizes the risks for the patient.

With these considerations in mind, surgeons from the University of California have reduced the number of incisions for laparoscopic kidney surgery from 6 down to 1. The technique even hides the scar in the belly button. In comparison, regular kidney surgery can require an incision as long as 12 inches or 30 cm. Overall, the approach reduces the risks and complications for patients as well as the recovery time. The result is a requirement of only 3 days hospital stay.

While the partial nephrectomy performed using laparoscopic surgery is certainly an important improvement over complete kidney removal using standard surgery, other techniques are even better for patients. In this regard, one option is called radio frequency ablation. For this treatment, a small needle probe is inserted into the kidney tumor where it heats up and stresses the cancer cells so that they die. The result is that much of the kidney can be saved while the cancer cells are eliminated.

Another related option for treating Kidney Cancer is the use of freezing or cryogenic techniques. This treatment involves injecting icy cold fluids directly into the tumor to cause the cells to freeze and die. Based on research from Johns Hopkins University Hospital, the treatment effectiveness for tumors of 1.5 inches or 4 cm in diameter or less is 100%. For tumors of 2.75 inches or 7 cm in diameter, the success rate is almost 100%. Evaluations of patients 3 years following such surgery have found no recurrence of the cancer.

In comparison to other treatments, these last techniques are far less complex and can be completed without recovery in hospital.

For those cancers that are resistant to both chemotherapy and radiation therapy, surgical approaches are the next best option. Unfortunately, the majority of surgeons are still using techniques that are significantly outdated and increase the risk of serious complications for patients. What this means is that patients and their supporters need to push their health care providers to embrace the newer, more effective approaches that have been developed and tested. These newest techniques are by no means cutting edge so it is about time that surgeons begin to use them.

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