How is metastatic kidney cancer surgically treated?
Often, the initial treatment for metastatic kidney cancer is radical nephrectomy, removal of the entire kidney, adrenal gland, and fat that surrounds the kidney along with regional lymph nodes (view video of lap radical nephrectomy). In the setting of metastatic kidney cancer, this surgery is known as cytoreductive (pronounced s-eye-toe-reductive) laparoscopic nephrectomy. The term cytoreductive simply refers to the fact that the surgeon is attempting to remove as much of the kidney cancer as possible knowing that there are other sites in the body that still have the disease.
In the past, it was thought that removing the kidney only helped to improve the symptoms of kidney cancer which can include bleeding and pain. More recently, cytoreductive radical nephrectomy has been shown to extend the time of survival in kidney cancer patients who are good candidates for surgery (generally healthy patients).
Cytoreductive radical nephrectomy is often a more difficult operation when compared to a standard radical nephrectomy as the disease may no longer respect normal tissue planes and the kidney cancer can sometimes spread into organs around the kidney or even through the veins of the kidney. In the past, cytoreductive radical nephrectomy was only done through an open approach using a large incision. Open nephrectomy involves a large incision with direct visualization of the kidney. More recently, in selected centers that have a large experience with laparoscopic kidney surgery, cytoreductive radical nephrectomy can be done with a laparoscopic approach. The laparoscopic cytoreductive radical nephrectomy procedure involves several small incisions and operating with a camera (view video of lap radical nephrectomy). Both approaches involve exactly the same operation, but patients undergoing a laparoscopic procedure may have a shorter hospital stay, less blood loss, and may be able to obtain medical treatment for the disease sooner following surgery. Laparoscopic cytoreductive nephrectomy for metastatic kidney cancer is not always feasible as there are still limitations to what can be done with laparoscopic technique. It is important to meet with a surgeon at a medical center that offers both techniques so as to get an unbiased opinion on which technique is likely to be best (both effective and safe) for the individual patient.
In some cases, patients who present with metastatic kidney cancer may also undergo surgery to remove the metastatic disease. When a patient has a single focus of metastatic disease (only one spot with disease not in the kidney can be identified) that can easily be removed, removal of the metastasis can improve survival. There are even survival benefits when the metastatic tumor is merely reduced in size surgically rather than completely removed. These benefits have been most clearly demonstrated when kidney cancer has spread is limited to just the lung or the brain.
Traditionally, medical therapy for kidney cancer has been challenging because traditional chemotherapy and radiation are ineffective. Medicines that activate the body's natural immune system to fight the kidney cancer have been first-line medical treatment, and they improve survival in some patients for several months. However, medication for metastatic kidney cancer has recently changed dramatically with the introduction of new classes of medications which have never previously existed.