Surgical treatment of kidney cancer

Surgical treatments for kidney cancer include:

1. Radical nephrectomy

(1) Indications: Radical nephrectomy is indicated for tumors confined to the perirenal fascia. Before surgery, a systematic examination of the lungs and abdominal CT scans must be performed. If there is pain in the sacral system or elevated blood alkaline phosphatase, a whole-body radionuclide bone scan should be performed to exclude bone metastases. If metastases are found, radical nephrectomy is generally not considered. Renal cancer with renal vein and/or inferior vena cava tumor thrombi is not a contraindication to radical nephrectomy, but the status of the intravenous tumor thrombi must be understood before surgery to facilitate surgical resection.

(2) Scope of surgery: The scope of radical nephrectomy for renal cancer is: the perirenal fascia, ipsilateral adrenal gland, upper 1/2 ureter, ipsilateral lymph nodes starting from the origin of the superior mesenteric artery, down to the origin of the inferior mesenteric artery, the inferior vena cava and para-aortic lymph nodes). When performing a nephrectomy for renal cancer, the renal artery and vein should be ligated first. The most critical thing about the operation is that it must be started from outside the perirenal fascia. According to statistics, about 25% of renal cancer operations have penetrated the renal capsule and entered the perirenal fat. Adrenalectomy is suitable for selected larger cancers in the upper part that are adjacent to the adrenal gland. If the tumor is located in the lower half of the kidney, the ipsilateral adrenal gland can be retained. The scope of lymph node removal is still controversial. Generally, the area from the origin of the superior mesenteric artery below the diaphragm to the origin of the inferior mesenteric artery, as well as the inferior vena cava and para-aortic lymph nodes is considered complete lymph node removal. There are also advocates for local lymph node removal, that is, removal of lymph nodes near the renal pedicle.

2. Renal tissue-sparing nephrectomy For renal cancer less than 4 cm (some advocate <3 cm) and located superficially or at one pole, renal tissue-sparing nephrectomy such as partial nephrectomy (single pole or middle wedge) or even tumor enucleation can be considered. However, most people advocate that this surgery is mainly suitable for cases with a mass <4 cm, bilateral renal cancer, solitary renal cancer, or contralateral kidney dysfunction. In addition, it must be clear before surgery that the tumor is localized and has no metastatic lesions.

All renal cancer surgeries that preserve renal tissue must be closely followed up. 4-6 weeks after surgery, renal function and excretory urography should be reviewed. If renal function is poor, ultrasound examination can be performed instead. Liver, renal function, lung, abdominal CT1 or ultrasound examination should be performed every six months after surgery to check for renal tumor recurrence. After 4 years, the examination should be conducted once a year. If local recurrence is found, nephrectomy can be performed again.