Robotic surgery, which uses a robot to give surgeons greater precision and control during surgery, is a powerful tool for treating kidney cancer. But a significant proportion of people who have this disease don’t need it.
We usually can catch kidney cancer early enough that the disease isn’t life-threatening for our patients, and many older patients may not need treatment at all. However, larger tumors or those that are beginning to spread may put patients’ lives in danger without surgical intervention.
Hearing those three words – “You have cancer” – is scary for anyone. It’s a stressful time with a lot to take in. It’s important to understand why we recommend robotic surgery for large kidney tumors, what the surgery is like, and your options if the cancer returns.
Who needs robotic kidney cancer surgery?
One important factor in deciding what patients need robotic kidney cancer surgery is the stage of their disease, or how advanced it is. We use the American Joint Committee on Cancer’s staging system, which identifies how advanced kidney cancer is based on several pieces of evidence:
- Stage 1: The tumor is less than 7 centimeters (about 2.75 inches) across and hasn’t spread out of the kidney
- Stage 2: The tumor is more than 7 centimeters across but still hasn’t spread out of the kidney
- Stage 3: The tumor is starting to spread and may have spread to a major vein
- Stage 4: The tumor has spread beyond the connective tissue surrounding the kidney and may have spread to other organs
Patients with stages 2 and 3 likely will need removal of the entire kidney. These tumors are larger and may spread to other organs if left untreated. In most cases, this can be done as minimally invasive surgery using laparoscopy with or without robotic assistance. However, most people diagnosed with kidney cancer are older. The average age of a patient at diagnosis is 64, and the disease is rare in anyone younger than 45.
Doctors also look at how well a patient’s kidneys are working and if there are any tumor related symptoms as part of their decision to recommend surgery. Small kidney tumors in stage 1 often don’t cause symptoms, but larger tumors in stages 2 or 3 can cause issues that speed up the need for surgery. These symptoms include:
- Anemia, or low levels of red blood cells
- Blood in the urine
- Fever that won’t go away after a few days
- Unintended weight loss
Request an appointment with one of our urologists to discuss your options for kidney cancer treatment.
The advantages of robotic surgery for kidney cancer
I use laparoscopy with robotic assistance for most stage I tumors, which I treat with partial nephrectomy, while I use laparoscopy with or without robotic assistance whenever possible to remove large kidney tumors in stages 2 or 3. Robotic/laparoscopic surgery has several advantages over traditional open surgery, including smaller incisions, faster recovery time, and the ability to save more of the patient’s kidney. Our doctors perform more robotic kidney cancer surgeries than any other provider in North Texas.
Using robotic surgery to treat kidney cancer means I can be more precise during surgery. This reduces the risk of leaving any part of the tumor behind and increases the amount of healthy kidney tissue I can leave in place for patients who are undergoing partial nephrectomy.
As with any surgery, time is always a factor when we’re removing kidney tumors. During partial nephrectomy, there is a period of no blood flow to the kidney during the procedure, and there’s a chance of the patient developing chronic kidney disease if the kidney is cut off from its blood supply for too long. This risk is lower for patients who have only part of their kidney removed than for a patient who has a total kidney removal. Robotic surgery lets us work faster than we could with traditional surgery to reduce this risk.
Robotic surgery also allows doctors to more easily remove large kidney tumors on the outside or inside of the kidney. Prior to robotic surgery, when tumors were completely within the kidney, doctors had to remove the entire kidney through a procedure called a radical nephrectomy. Now we can use robotic surgery to remove just the part of the kidney with the tumor through a procedure called a partial nephrectomy.
Common concerns after surgery, and options if cancer returns
People often ask me about the risk of complications of kidney cancer surgery. But complications are a risk with any surgery.
If we’re able to remove just the kidney tumor without having to remove the patient’s entire kidney, it’s possible the patient may have bleeding or leakage of urine into the abdomen, or belly, after surgery. These complications are much less common than they used to be, and we can manage a problem quickly if it does arise. For example, bleeding after surgery can be managed with angioembolization, a minimally invasive procedure where a catheter is threaded through the groin artery towards the bleeding artery in the kidney, and this bleeding can be blocked without the need for another surgery.
One of the main questions I get from my patients is this: “Will my cancer come back?” Unfortunately, we can’t say for sure that a patient’s kidney cancer will never come back or that a new tumor will never develop. But there are alternatives to surgery available to treat kidney cancer that does return or new kidney cancer that develops. Learn more about our available kidney cancer treatment options.
Patients also may benefit from clinical trials if their kidney cancer comes back or doesn’t respond to treatment. These trials provide access to new options that aren’t yet available anywhere else.
People with kidney cancer, especially larger tumors, have important decisions to make about their care. But the important thing to remember is we can fight this disease. Robotic surgery and other treatment options give people throughout our region an excellent chance of a full, healthy life beyond kidney cancer.