In our program, patients with small renal tumors are treated with one of the following methods:
- Expectant management
- Laparoscopic or percutaneous cryotherapy
- Laparscopic partial nephrectomy
- Laparscopic radical nephrectomy
- Open partial nephrectomy
- Open radical nephrectomy (no longer done for small tumors)
The "watchful waiting" approach is appropriate when tumors are too small to be characterized and need to be followed radiologically to determine their clinical significance. Observation is also an appropriate option for elderly patients with small (less than 3 cm), indolent tumors with slow growth rates, as renal cell carcinoma seldom metastasizes before reaching the size of 4cm. Dr. Teigland and the multidisciplinary team at CMC determine which patients should be managed immediately and coordinate appropriate follow-up imaging. If it becomes necessary, patients will be treated later with one of the methods described below.
This FDA approved treatment uses cold (-40 degrees C) to remove tumors of 4 cm or less. Depending on the tumor location, cryotherapy can be done laparoscopically or percutaneously.
Cryotherapy can completely destroy small tumors without the risks of a major operation.
Patients are admitted the day of the procedure and usually go home the next day, reporting minimal post-procedure pain. Percutaneous core biopsies are obtained at the time of removal for prognostic information. Patients are admitted to the McKay urology service post-procedure, where follow-up visits and radiologic studies are coordinated.
Laparoscopic Partial Nephrectomy
Since 2004, Drs. Chris Teigland and Kent Kercher (laparoscopic general surgeon and
co-director of CLASP) have performed laparoscopic partial nephrectomies using the hand-assist technique. This minimally invasive surgery causes dramatically less pain than open partial nephrectomy, requires a much smaller incision (2.5 inch vs. 12 inch), and permits a rapid post-operative recovery. The resection is guided by intra-operative ultrasound to insure complete excision of the tumor. Gross margins are evaluated by a pathologist who is present in the operating room at the time of resection. Patients are admitted to McKay Urology service postoperatively. Patients are typically discharged 3-4 days after the operation and are able to return to work within three weeks. Follow-up visits and radiologic studies are coordinated by McKay Urology.
Laparoscopic Radical Nephrectomy
This minimally invasive surgical technique for en bloc kidney removal causes dramatically less pain than open radical nephrectomy through a flank or subcostal incision and permits a rapid postoperative recovery. This approach is most appropriate in younger patients with an unusual, small centrally located tumor that does not lend itself to partial nephrectomy. Patients are admitted to McKay Urology service postoperatively and are typically discharged 3-4 days after the operation. Follow-up visits and radiologic studies are coordinated by McKay Urology.
Open Partial Nephrectomy
The traditional approach to removing small kidney tumors is still appropriate for certain technically difficult small tumor presentations in younger patients where conservation of renal tissue is imperative. However, recovery from a flank incision is painful and requires 4-5 day hospitalization and up to two months away from work.
Open Radical Nephrectomy
Open radical nephrectomy is no longer appropriate for any patient with a small renal tumor. This operation is now done only rarely for the patient with a renal tumor associated with significant vena caval or nodal involvement. Since 2001, 98 percent of all radical nephrectomies for renal cell carcinoma performed by McKay Urology have been done laparoscopically.
For more information, contact McKay Urology at 704-355-8686.