Kidney Cancer Treatment

The management of kidney masses that have not spread is with surgery, although some small masses can be observed safely over time. When a small mass has been removed the cure rate is very high (often >95%). The important things to know about your mass is what stage and grade it is when it has been removed – this information helps with prognosis.

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 Treatment

When 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.

Partial Nephrectomy for Bilateral Tumours

A 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 surgery

All 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.

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.).

This advice is the same as the question about when I can get back exercising/going to the gym. The reason for this is that you can develop a hernia (which is a weakness at the wound site, and bowel can pop through it which is quite serious sometimes). If you did develop a hernia and had to get it repaired, then you could be out of work for over three months letting this heal. So, with exercise in mind, I would advise walking only for 3-4 weeks after surgery, with a slow introduction of aerobic exercise (cycling, running etc.). I would advise against lifting heavy weights, Pilates or Yoga (where core abdominal work is being used) for 3 months

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.