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1) What is kidney cancer and how common is it?

Renal cell carcinoma is the most common type of kidney cancer. Kidney cancer accounts for about 3% of all cancers in adults, with an incidence in men twice as high as in women.

The average age of people who develop kidney cancer is 65 years. It is a cancer that is not common in people under the age of 45, and is most common in people between the ages of 55 and 84.

2) What are the possible risk factors for kidney cancer:

• Smoking
• Being obese or overweight
• Exposure to certain substances at work (asbestos and a type of metal called cadmium, certain herbicides, benzene, other organic solvents, especially trichloroethylene and coke from steel mill furnaces).
• Certain types of radiation therapy.
• Hypertension. It is unclear whether the higher risk is caused by antihypertensive drugs or by the condition itself.
• Gender and race. The disease is thought to be about twice as common in men as in women. African-American patients have a slightly higher rate of kidney cancer than Caucasians.
• Chronic kidney disease on dialysis
• Family history. Brothers and sisters of people with kidney cancer have a much higher chance of developing the disease.

3) What are the symptoms of kidney cancer?

In the early stages, kidney cancer usually causes no symptoms and is discovered incidentally during a simple ultrasound examination.

However, as the tumor grows, symptoms may include:

• Blood in the urine (hematuria)
• A palpable mass in the kidney area.
• Persistent pain in the ribs near one kidney
• High blood pressure or anemia
• Unexplained weight loss.
• Weakness, fatigue, and fever that cannot be attributed to another cause.

4) How is kidney cancer diagnosed?

If you have any of the above symptoms and after a clinical examination, your doctor may request some additional laboratory tests:

• Urinalysis: Hematuria occurs in 40-60% of cancer cases.
• CBC: The erythrocyte sedimentation rate (ESR) is often increased in patients with kidney cancer, while the complete blood count can diagnose anemia.
• Ultrasound: It is a simple, painless and harmless imaging test that can provide some information about the presence of kidney cancer.
• CT scan of the abdomen and retroperitoneum: It is the test of choice for diagnosis, but also for staging the disease, that is, it shows whether there is extension to the lymph nodes or other organs of the abdomen.
• Magnetic tomography of the abdomen and retroperitoneum: It offers the same as CT scan, but in some cases it is advantageous in staging the disease.
• Biopsy: In some cases where there are doubts from the imaging tests, the doctor may recommend a biopsy. A thin needle inserted through the skin takes a small sample, which is sent for examination. The biopsy is performed using ultrasound or, more often, CT scan.

5) What is the treatment for kidney cancer?

• Segmental nephrectomy
• Radical nephrectomy

6) What is a segmental nephrectomy?

A partial nephrectomy or lumpectomy is the removal of only the diseased part or tumor of the kidney in order to preserve the larger and healthy part of the kidney, in patients with a small and easily operable kidney tumor.

Partial nephrectomy should not be confused with:

1. radical nephrectomy, which is the total removal of the kidney with the perineal fat and the adrenal gland, in cases of large kidney volume,

2. simple nephrectomy, which is the removal of only the kidney, for benign kidney diseases (such as in the case of hydronephrotic non-functioning kidney, etc.

7) What are the advantages of partial nephrectomy over radical nephrectomy?

1. Preservation of renal function to the maximum extent.

2. Avoidance of renal failure that can usually be caused in the remaining healthy kidney after radical nephrectomy.

3. Avoidance of the risk of removing the kidney in case of benign tumors. It is noted that in a percentage ranging from 8% to 28%, the kidney is removed for a benign tumor, where radical nephrectomy is not needed.

4. Better quality of life after partial nephrectomy, without particular dietary or physical restrictions, since it is maintained and renal function to the maximum extent possible.

5. The chances of cure after partial nephrectomy are the same as after radical nephrectomy and are close to 100% in the absence of distant metastases

10) How is partial nephrectomy performed?

• Open
• Laparoscopically
• Robotically

11) What are the advantages of robotic partial nephrectomy compared to the other 2 methods?

In robotically assisted partial nephrectomy, the unique advantages of robotic technology become even more evident.

The main reasons for the worldwide establishment of robotic surgery in the total and safe removal of kidney tumors, with full preservation of the remaining healthy part of the kidney, are:

• Due to the three-dimensional and magnified vision, we achieve easier and better recognition of the anatomical details of the renal area, the boundaries of the tumor and the pathological anatomy.

• Due to the precision and freedom of movement of the articulated robotic arms, which allow us to operate as if the surgeon’s hands were inside the patient’s body, we achieve more detailed preparation of the kidney vessels and adjacent anatomical elements.

• Improved technique of transection and complete resection and removal of the renal tumor

.• After removal of the tumor, the possibility of easier and more precise suturing of the renal wound is given, which facilitates the completion of the operation in an acceptable time of renal ischemia with the least problems of complications (urine leakage and bleeding).

• Increased ability to maintain maximum healthy renal mass, without the risk of residual renal tumor, even in difficult cases, resulting in fewer problems of relapses and a longer survival time without signs of the disease.

• Better clinical course in most cases.

• More chances of maintaining renal function to the maximum extent.