Some patients will need a biopsy of their kidney mass in aid in the decision making. A biopsy is where a sample of tissue is taken using a needle stuck directly into the mass - a procedure that is performed under local anaesthetic. This can help the decision making process for the doctor and can help us know exactly if the mass is a cancer or not. We don’t always biopsy the kidney mass as sometimes the likelihood of this being cancer is so high that there is little point.
Partial Nephrectomy - Minimally Invasive Kidney Cancer TreatmentWhen surgery is necessary, small kidney masses should be removed by excising the lump only – not the whole kidney. This is called ‘Partial Nephrectomy’. This should be performed minimally invasively in my opinion – either by laparoscopic or robotic surgery (see videos below), as it has all of the advantages of keyhole surgery. These include quicker recovery, less pain, shorter hospital stay, quicker return to work and small hidden scars. Removing the lump only, and not the entire kidney has many advantages such as less risk of kidney failure, probably better long-term survival (data too immature to say right now) and retains options for those 5% of patients that develop new cancer on the opposite kidney over their lifetime. The majority of small kidney cancers now suitable for removing only the lump, and not the whole kidney by keyhole surgery.
When a large kidney mass is present the entire kidney is removed, and most commonly this is done by keyhole surgery. Many of the scars from this operation are hidden from sight – one in the belly button, and the kidney is removed from the body from an area under the belt line so that no one can see the scar. This also has the same advantages of keyhole surgery – quicker recovery etc.
Sometimes for the most effective kidney cancer treatment, it needs to be operated on by open surgery, but nowadays the requirement for this is not that common.
The surgery is generally very safe, and most patients do very well, however, there are risks associated with the surgery which I will have discussed with you. Find out more about Pre and Post Op instructions HERE.
Preserve Renal FunctionThe main benefit of partial nephrectomy (just removing the lump) over surgery to remove the whole kidney is that it preserves kidney function. This has a few advantages for you. Studies have shown that a considerate proportion of people who undergo this surgery have unknown kidney disease which has never become apparent as they have two functioning kidneys. If a kidney is removed then it then can become an issue (called kidney failure) with a small proportion of patients requiring dialysis.
In addition, about 5% of patients with kidney cancer develop a new kidney cancer over the course of their lifetime, and if a kidney has been previously removed then this limits your options somewhat.
Lastly, it is thought that preserving kidney function may have a positive impact on the overall lifespan of a patient, but this technique is so new that we do not have enough information to prove this currently.
Partial Nephrectomy for Bilateral TumoursA small proportion of patients will have multiple tumours, for example, two or three in the same kidney, or tumours on both kidneys at the same time. The options for dealing with these largely depends on how the scan looks and will be discussed with you at the time of your consultation. Often keyhole surgery is still an option in these cases, requiring separate operations to address each side. The reason for separating the two sides is to allow the kidney function to recover fully after the surgery. The tumours can often differ in size – a decision on which side to tackle first will be made based on the appearances on the scan and taking the patient’s medical history into account. Learn what to expect during admission for partial nephrectomy.
Enhanced Recovery Protocol following surgeryAll patients follow an enhanced recovery protocol after surgery for kidney cancer, meaning that your care is progressed at each point as quickly as possible because you recover quicker this way. The first goal is to remove all tubes inserted at the time of your surgery at 6 am on the first day after your surgery. This means that the urinary catheter (which drains your urine), a drain that comes out of your abdomen and your intravenous drip are all removed. You are then encouraged to walk as much as possible and resume a normal diet. You are encouraged to eat small healthy portions of food which will not upset your stomach too much. You will receive 3 doses of an intravenous antibiotic as part of your recovery.
The main aim is that you feel well enough to go home 48 hours after your surgery. By getting up and walking around soon after your surgery, you will significantly reduce your risk of developing a chest infection/pneumonia and a clot in the leg which can travel to the lungs (called a pulmonary embolus - which can be fatal). By leaving hospital quickly, you also reduce your chances of getting a hospital-acquired infection.
Laparoscopic or Robotic – which is for me?Robotic surgery doesn’t always mean better, there are many situations that laparoscopic surgery to remove your kidney cancer will be equally as good. This will be discussed with you at the time of your consultation. Both techniques have the same recovery, as they are both keyhole.
Why did I get Kidney Cancer?Many patients will ask me at the time of their consultation how did they get kidney cancer. I explain to them that with the exception of a small percentage of patients, it most likely has happened by chance. In some patients, they have very strong family histories of kidney cancer because they have inherited conditions. This means that a particular condition that is strongly linked to kidney cancer is passed down from generation to generation. This however only accounts for about 5% of kidney cancers. Some conditions that can be associated are named Von Hippel-Lindau Disease, Burt Hogg Dube, and Hereditary papillary renal cell carcinoma. If you don’t have hereditary risk factors, cancer developed because of what’s called ‘sporadic mutation’ in a gene: this is where an abnormality has developed in a cell by pure chance. We talk about a person’s risk factors for developing cancer, and in kidney cancer, these are related to: • Smoking – up to a third of kidney cancers are thought to be associated with smoking • Gender – being a man nearly doubles your risk of kidney cancer • Race – black people have higher rates of kidney cancer • Age – Usually age for developing kidney cancer is between 50-70 years old • Being overweight/obesity is associated with a higher risk of kidney cancer
How Soon Can I get Back to Work, Exercise and Driving?Most people are keen to get back to work, exercise and driving as quickly as possible after surgery because they want their normal routine back. When asked “when can I get back to work?” – it largely depends on what your occupation is! In general, after keyhole surgery on the kidney (laparoscopic or robotic kidney surgery for kidney cancer or urothelial cancer), most people will say they feel fully normal a month after surgery. This can vary from patient to patient. For example, a younger patient tends to bounce back quicker than an older patient, but it largely depends on how healthy you are, to begin with. But the opposite is also true - a fit exercising 70-year-old will recover quicker than an unfit 50-year-old!
Pain is well controlled after keyhole surgery and tends to disappear pretty quickly. Such that after only a matter of days, minor pain relief is needed (paracetamol, occasionally something a little stronger). I encourage all of my patients to get up walking and moving as quickly as possible after surgery because this has a major benefit in helping you recover more quickly (it also reduces complications that can occur e.g. pneumonia, clots in the leg etc.).
If however, you work in a manual job, you can’t lift anything heavier than a shopping bag for a month after surgery, and then you need to gradually introduce the manual activity. So many patients in these jobs go back to the understanding that they are doing light work, and if that is not possible then they just stay out of work. This is something we can discuss and can assess based on how what type of surgery you had and how well your recovery is going.
Getting back to driving after keyhole surgery on the kidney?In general, two weeks after surgery is the advice given here. But you have the responsibility of making sure you are fit to drive also. If you are in pain and not recovering very quickly, then you need to use common sense and stay away from driving until you feel better. This is mainly because you need to be able to use your legs to brake in an emergency, and pain the abdomen would interfere with this. Also, you need to check with your insurance company, as the policies differ with all of them.
Click the button below for common questions and answers. hope you find this useful.
Kidney Cancer Informational Videos
Click on the videos below to find out more