Partial Nephrectomy Removes Cancer, Saves Kidney
“Diagnosis of kidney tumors is on the rise,” says Mohamad Allaf, M.D. Associate Professor of Urology, Oncology, and Biomedical Engineering, and Director of Minimally Invasive Surgery. “Most of these patients are being treated with complete kidney removal,” a procedure called nephrectomy. Although the procedure is common, the complications are nothing to take lightly: “In some instances this may result in kidney failure, cardiovascular side effects, and the need for dialysis,” Allaf explains. But there’s another option, one that Allaf says is often overlooked: partial kidney removal, or partial nephrectomy. The operation offers the “best of both worlds,” in that it removes the cancer, but still saves the kidney. As surgical procedures go, it is technically complex, and an operation not very familiar to many surgeons. “Many surgeons who do offer it use open surgery, or only perform it on the smalles t and least complex tumors.” This is why Allaf, who directs the Brady’s kidney cancer efforts, recommends that patients seek a second opinion. “There are about 60,000 new cases of kidney cancer per year in the U.S. and approximately 10,000 urologists. If averaged out, each urologist will see only six cases per year. Getting a second opinion at a busy center is critical,” he says. “Often, patients come to me after a sur geon has wanted to remove their entire kidney, or save the kidney but use a big flank incision, which is associated with hernia formation and other complications,”
Urologists at Johns Hopkins offer all treatment options to patients, including active surveillance for select tumors (see story), minimally invasive approaches such as robotic-assisted laparoscopic partial nephrectomy, and open surgery when appropriate. Allaf and his team have one of the lar gest experiences in the world in robotic partial nephrectomy, performing more than 400 robotic kidney procedures a year. In two recent studies published in the Journal of Endourology, Allaf ’s group studied the outcome of patients undergoing robotic partial nephrectomy at Johns Hopkins for complex tumors— those that are completely on the inside of the kidney, called intrarenal tumors, and those that are on the back of the kidney, called posterior tumors. The results indicated that in experienced hands, these patients did just as well as those with less complex tumors. In fact, important safety measures reported in those studies such as complication rates, ischemia times, and positive surgical margins were among the best in the published literature. “We are very encouraged by our excellent results but still emphasize that we offer our patients all available options and reject a ‘one-size-fits-all’ approach. For patients needing surgery, we offer world-class care,” Allaf says. “In saving the kidney, we not only take care of the cancer, but we give the patients the maximal chance at not developing other complications including kidney failure, the need for dialysis, and other related problems. Some people come to us with one kidney, and in those patients , we’ve developed techniques that potentially can make it amenable to a minimally invasive robotic approach.”
Even difficult cases, such as multiple tumors, large tumors, cancer that invades deep into the kidney, unusual anatomy, or pre-existing kidney disease can be done with minimally invasive robotic techniques.
Even difficult cases, such as multiple tumors, large tumors, cancer that invades deep into the kidney, unusual anatomy, or pre-existing kidney disease — all of which previously were thought not ideally suited for a minimally invasive approach — can be done with minimally invasive robotic techniques. “It’s increasingly rare for us to have to remove the entire kidney for tumors less than 4 centimeters in size,” Allaf adds. For the team of urologists, anesthesiologists and nurses, “this is what we do, day in and day out, and to us, even very complicated cases are usually a straightforward robotic-assisted partial nephrectomy.” The average hospital stay is one to two nights.