Improving Treatment for Kidney Cancer Patients
At the Podium – May 2006
By Sam Bhayani, MD
With only 36,000 cases of kidney cancer diagnosed in the United States annually, it is the least common urological cancer. Unlike other urological cancers, such as those of the bladder or prostate, the only treatment for kidney cancer is surgery.
These two factors – the rarity of kidney cancer’s occurrence combined with its single treatment option – means a facility with an expertise in treating this cancer can be as uncommon as the disease itself. Fortunately, that experience is available at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, where our team of urologic surgeons is leading the way in kidney cancer care.
One of the areas in which we excel is laparoscopic kidney surgery. In fact, the world’s first kidney removal using laparoscopic surgery was performed in 1991 by a team of urologic surgeons at Washington University School of Medicine. Since that time, this minimally invasive technique has become the surgery of choice for kidney cancer treatment. The three small incisions needed to complete the procedure substantially reduce patients’ pain and discomfort and hasten their recoveries. The procedure is a vast improvement over the large incision and rib removal required during traditional surgery.
In addition to being pioneers in laparoscopic kidney surgery, we continue to integrate into our program the most advanced techniques and instrumentation available for this procedure. These innovations allow us to continually decrease the length of time it takes to complete surgeries while increasing their safety and efficacy. We now routinely perform laparoscopic nephrectomies and partial nephrectomies in two to three hours, rather than the usual three- to five-hour time span. This speed does not compromise safety – our complication rate is one of the lowest in the country for this type of surgery.
How is this possible? The critical difference is experience and a sophisticated technical approach that involves getting early control of the vascular supply to the kidney first, rather than dissecting the kidney and then cutting off the blood supply. Special instrumentation, particular knowledge of the anatomy and its variations, and technical expertise all play a role in the success of this laparoscopic procedure.
Although more complicated, advanced laparoscopic techniques often prove successful when applied to partial nephrectomies as well. This is important since the number of partial nephrectomies is bound to increase in coming years as tumors continue to be identified at earlier stages, well before symptoms develop. The reason for this increase is the incidental discovery of kidney tumors as patients receive CT scans for other medical reasons. In fact, a study I completed at Barnes-Jewish Hospital during 2004-2005 showed that the average size of a kidney tumor at diagnosis today is 4 centimeters, compared to 8 or 9 centimeters in the 1970s. Patients with these smaller tumors are ideal candidates for partial nephrectomy.
In an age when high blood pressure and diabetes are common diseases, the ability to remove a tumor while saving half or two-thirds of a patient’s kidney is an important goal. And if we can save that portion of kidney with as little discomfort to the patient as possible via a laparoscopic approach, that is even better.
As advanced as laparoscopic nephrectomy is, however, it is not the end of the road for kidney cancer treatment. At this time, the Siteman Cancer Center is one of only two major centers in the Midwest offering kidney cancer treatment for patients ineligible for any type of surgery due to their failing health or age. This group of patients may undergo percutaneous cryoablation, a procedure that involves inserting probes through the skin to freeze tumors in the kidney.
Currently this procedure is appropriate only for small tumors or for patients who have no other alternative. But because the technique holds promise for being the least debilitating kidney cancer treatment with the fewest side effects, our laboratory research is focused on expanding its application for the future. Through investigation of new cryotherapy techniques and probes, we are hoping to maximize the destruction of tumors while minimizing injury to the rest of the kidney.
The laparoscopic urologic surgery program at Siteman treats more than 200 patients with kidney cancer each year, making it one of the largest kidney cancer practices in the world. These patients benefit not only from the expertise passed down from the pioneers in the field but also from the ongoing refinements and discoveries made by current leaders in laparoscopic urologic surgery.