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Our kidney cancer program focuses on each patient as a unique individual. We aim to choose the best therapy through an experienced team of surgeons, medical oncologists, pathologists, and radiologists.
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Diagnosed With Kidney Cancer
We understand the anxiety that a diagnosis of kidney cancer can bring to the patient and their family. The most important thing one can do is to learn about this disease and enlist the help of an experienced team of physicians.
Johns Hopkins Studies
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Johns Hopkins Kidney Cancer Program
TREATMENT OPTIONS - Partial Nephrectomy
Partial nephrectomy is also referred to as "nephron-sparing surgery" or "kidney-sparing surgery." During partial nephrectomy the surgeon removes the tumor and saves the kidney. This is a delicate procedure that is highly experience dependent. NOT ALL PARTIAL NEPHRECTOMY PROCEDURES ARE THE SAME. For example, surgeon may cut half the kidney for a very small 1cm tumor while another may be able to save 90% of the kidney—a significant difference for your kidney health! Additionally, partial nephrectomy can be performed via open or robotic-assisted laparoscopic surgery and a surgeon trained and experienced in both techniques is ideal. There are many other critical variables involved that are best handled by an experienced team.
Not necessarily! Studies have shown that a successful partial nephrectomy removes the tumor successfully and achieves cure rates similar to total kidney removal. This has been well established for tumors < 4cm and there is emerging research suggesting that the same is true for larger tumors. An experienced surgeon can look at the CT or MRI scan and make an assessment regarding the feasibility and safety of a partial nephrectomy. Less experienced surgeons may erroneously decide that it is "best to take out the entire kidney." Partial nephrectomy is a relatively rare complex procedure and there is no substitute for experience in helping make the right decision.
The major advantage is preserving kidney function. According to a classic study published in the New England Journal of Medicine*, patients who have poor kidney function are more likely to suffer from heart disease and die from it. Additionally, a recent study in the Journal of the American Medical Association# verifies that partial nephrectomy patients live longer than patients who have had total kidney removal. These results, while important, may not apply to everyone and thus the benefit for you personally should be discussed with your urologist.
Who is the ideal partial nephrectomy patient?
First and foremost, the tumor must be in a location that would make a partial nephrectomy feasible and safe. Experienced surgeons specializing in partial nephrectomy have the best chance at removing difficult tumors successfully.
Beyond this however these are ideal patient characteristics:
The surgeon exposes the kidney and performs a thorough evaluation of it. After verifying that there are no other tumors in the kidney and that there is no spread of the tumor, the surgeon then cuts out the tumor and then reconstructs the kidney. An intraoperative ultrasound is usually performed to verify tumor location and configuration. We usually cut the tumor out and biopsy the surface left behind. This is verified to be "clean" prior to concluding the procedure to ensure that the tumor is COMPLETELY removed.
Do most urologists perform partial nephrectomy?
Kidney tumors are rare and small kidney tumors are even rarer. Surgeons who routinely perform partial nephrectomy are thus exceedingly rare! Studies estimate that partial nephrectomy is woefully underutilized due to the skill-set and experience required to be comfortable with this advanced procedure. Surgeons have traditionally removed the entire kidney as this is an easier procedure to master. Experienced partial nephrectomy experts rarely have to remove the entire kidney in this setting. For small kidney tumors (<4cm), our experts perform a partial nephrectomy >90% of the time when surgery is undertaken. It remains that for the rare tumor, it might be technically impossible to save the kidney. Two surgeons may disagree on what constitutes a tumor that can be removed via partial nephrectomy. We advise that you consult with an expert prior to making a decision.
Since the kidney is left in place the raw surface where the tumor was cut can bleed. A delayed bleed occurs rarely (1-2% of the time). Signs and symptoms of this are severe flank or abdominal pain, bruising on the side, or blood in the urine. Treatment for this is usually conservative (bedrest or a radiology procedure called embolization in the event of a pseudoaneurysm). A recent multi-institutional study headed by Johns Hopkins urologists revealed that this complication can usually be managed with a radiology procedure called selective angioembolization.* While rarely required, it is best that you ensure that your care team/hospital are experienced with this rare procedure.
These two complications do not occur when the entire kidney is removed. Recent Johns Hopkins studies reveal that these complications are exceedingly rare in our patients.
Is there a minimally invasive way to perform partial nephrectomy?
*( Allaf ME, Bhayani SB, Rogers C, Varkarakis I, Link RE, Inagaki T, Jarrett TW, Kavoussi LR. Laparoscopic partial nephrectomy: evaluation of long-term oncological outcome. J Urol. 2004 Sep;172(3):871-3.)
Should I have an open or robotic-assisted laparoscopic partial nephrectomy?
In general the robotic approach yields smaller incisions,
Our commitment is to provide the best care with the most minimally invasive approach while maximizing safety and effectiveness.
What is "ischemia time" and what do I need to know about it?