When is this procedure indicated?
When the goal of treatment is to cure localized kidney cancer, surgery is the treatment of choice. Partial nephrectomy is a surgical procedure that involves the removal of tumor tissue while sparing the remaining healthy kidney tissue and is indicated in all cases where it is technically possible to remove the tumor tissue while sparing an adequate portion of healthy kidney tissue. For these reasons, partial nephrectomy surgery is not always feasible. The benefits associated with preserving some of the kidney tissue are lower risk of post-operative renal failure, lower risk of post-operative cardiovascular events, and in some cases, improved long-term survival.
How is it performed?
The procedure can be performed with an open surgical approach (through a surgical incision), with a laparoscopic approach (through 4 or 5 incisions between 5 and 15 millimeters through which laparoscopic surgical instruments are inserted) or with a robot-assisted approach (through 5 or 6 incisions between 5 and 15 millimeters through which surgical instruments are connected to the arms of the Da Vinci® Surgical System robot-operator).
The procedure is conducted under general anesthesia and the patient is positioned on his or her side or supine. Surgery may involve: displacement of the liver, ascending colon and duodenum (right kidney) or displacement of the spleen, pancreas, descending colon and sigma (left kidney); isolation of the ureter, isolation and eventual ligation and section of the gonadal vessels (artery and vein); isolation of the renal vessels (one or more veins and one or more arteries) from the vena cava (right kidney) or the aorta (left kidney); opening of Gerota's fascia and exposure of the surface of the renal parenchyma; identification of the neoplastic lesion and intra-operative evaluation of its anatomical characteristics. If it is possible to proceed with a partial nephrectomy, the procedure may involve: momentary interruption of distributed vascular flow to the kidney by closure of the renal artery and vein, if necessary; incision of the surface of the kidney near the neoplastic lesion; development of a cleavage plane between the neoplastic lesion and the remaining renal parenchyma until the neoplastic lesion is removed; suturing of the renal calyxes, if necessary; hemostasis of the resection bed, which may include the use of sutures, clips, diathermocoagulation, and other hemostatic material; restoration of distributed vascular flow to the kidney if interruption was necessary; control of bleeding and closure of the Gerota's band, if necessary.
In 7 to 8 of 10 patients, no complications are observed after surgery. In some cases, the patient may have a fever requiring antibiotic treatment, bleeding may occur requiring transfusion or, even more rarely, interventional procedures, or urine may leak from the operated portion of the kidney requiring interventional procedures. Other complications are possible but rare and usually dependent on the patient's baseline health conditions.
Most patients after surgery have a full recovery of their daily activities without any limitation or worsening of their pre-surgery health status. Long-term risks include worsening of overall kidney function with the possibility of renal failure and recurrence of disease locally or systemically, requiring additional care.