Modern treatment of kidney cancer: The goal is to save the organ
Kidney cancer accounts for 2-3% of all cancers and usually occurs in the 6th and 7th decades of life.
Risk factors for kidney cancer include obesity, hypertension and smoking, while other factors have also been implicated, such as chronic use of antihypertensive drugs. In addition, the likelihood of developing kidney cancer increases if there is a 1st degree relative with a history of kidney cancer.
Most kidney tumors remain asymptomatic and are found incidentally during ultrasounds or CT scans that patients undergo for another reason. Rarely, there may be lumbar pain, hematuria and even more rarely a palpable mass in the kidney area.
Kidney tumors are treated surgically. Very often, in patients with large tumors, or in tumors with rich vascularization and contact with the large vessels of the kidney, or tumors that grow endophytically, that is, towards the interior of the organ, performing a radical nephrectomy is the only option. However, removing only the tumor and saving the remaining healthy kidney parenchyma is of particular importance for the patient and should be a priority in the treatment of this condition, as long as it is done with oncological safety. This is because it appears that in the long term the patient’s renal function is maintained significantly better, the risk of significant renal failure that could lead to dialysis in the future is reduced, while in addition the toxic effects of drugs used for various diseases are much less on the renal function of patients who have preserved both kidneys. Finally, we should consider that 10-15% of kidney tumors are benign, so it is important to save the kidney, especially in these situations.
By using the robotic technology of the Da VINCI Xi and X High Definition systems and all the capabilities it provides in the hands of a surgeon, we can in most cases precisely remove the tumor, saving the remaining kidney. By using the state-of-the-art BK5000 robotic ultrasound during surgery, where a contrast agent is also injected simultaneously, we can precisely identify the boundaries of the tumor. In addition, by using the firefly robotic technology, we see the precise blood supply of the organ and the tumor and we are given the opportunity to perform a hyperselective interruption of only the artery that supplies the tumor, keeping the remaining blood supply of the organ intact and affecting the kidney function to a minimum. The combination of these capabilities helps us to precisely remove the tumor while saving the remaining kidney, while at the same time because the operation is performed through very small holes there is a significantly faster recovery of the patient with a hospitalization time of usually 48 hours.
In addition, by using the robotic system we have the opportunity to approach the kidney retroperitoneally, without entering the abdominal cavity, which reduces irritation of the intra-abdominal organs and postoperative pain. This approach, which has been pioneered at the Athens Medical Center for 3 years, is particularly beneficial, as it offers direct and safe access to the kidney, especially in patients who have undergone multiple previous abdominal surgeries and in patients with chronic respiratory problems or chronic constipation.
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