Kidney cancer: treatment

Surgical treatment of kidney cancer is the main method of treating kidney cancer. Most often perform a radical nephrectomy.

There are a number of indications for nephrectomy.

1. Nephrectomy is the method of choice for the treatment of local forms of kidney cancer.
2. Radical nephrectomy is indicated in patients with kidney cancer with tumor invasion of the renal and inferior vena cava.
3. Nephrectomy is performed in patients with solitary metastases in combination with resection of the latter.
4. Palliative nephrectomy is indicated in patients with disseminated renal cancer to improve quality of life.

In the presence of metastases in regional lymph nodes necessarily conduct lymphadenectomy.

Lymphadenectomy in the treatment of kidney cancer is performed in order to: determine the stage of the process; prevention of local recurrence; increase in survival rate.

Lymphadenectomy in kidney cancer involves the removal of all fatty tissue with the lymph nodes surrounding the ipsilateral main vessels, from the level of the diaphragm legs just below the level of the superior mesenteric artery to the bifurcation of the aorta and inferior vena cava.

Improvement of diagnostic methods has led to the fact that the revealed kidney cancer is often of small size and is limited within the body. The localized kidney tumor is a new growth of T1a, T1b and T2 stages. When the size of kidney cancer is not more than 3 - 5 cm, it is possible to perform an organ-preserving operation (kidney resection).

According to Yu. G. Alyaev (2001), indications for organ-saving operations can be absolute, relative and selective.

Absolute indications for surgical treatment of kidney cancer are as follows:

• bilateral synchronous and asynchronous kidney cancer;
• cancer of anatomically or functionally the only kidney;
• cancer of one kidney and defeat by another non-cancer process, as a result of which the body undergoes significant changes and can not ensure the vital activity of the body.

A relative indication is cancer of one kidney and inferiority of the other with unexpressed renal failure.

Selective (elective) indications in patients with kidney cancer with a healthy opposite organ (five-year adjusted survival was 86.5%).

There are different versions of organ-preserving surgical treatment of kidney cancer:

• enucleation of kidney cancer;
• sphenoid resection of the kidney;
• resection of the kidney pole;
• heminephrectomy;
• extracorporeal resection with kidney autotransplantation.

In the last 10 years, thanks to the improvement of special instruments and the skill of physicians, laparoscopic kidney surgery is becoming an effective and less traumatic alternative to open radical nephrectomy in a certain contingent of patients. The first laparoscopic nephrectomy in kidney cancer was performed in 1990 by R. Kleiman. Currently, laparoscopic nephrectomy is widely used in kidney cancer. Compared with open surgery, it can reduce postoperative pain, as well as the length of the patient's stay in the hospital and the period of his recovery from surgery.

In most cases, laparoscopic radical nephrectomy is performed with small (<8 cm) localized renal cell carcinomas without local invasion, renal vein thrombosis or lymphadenopathy.

In patients with kidney cancer who underwent laparoscopic surgery, the results of a five-year survival rate are comparable with those of an open surgical manual.

Recently, there were reports of domestic authors about the use of laparoscopic access in kidney cancer. It is about laparoscopic access, not laparoscopic surgery, since the technique of the surgical manual itself does not differ from the standard one when using the peritoneal operative approach.

If the removal of the kidney neoplasm is impossible (severe intercurrent background, old age, small size of the neoplasm or unwillingness of the patient), one of the variants of minimally invasive surgery of kidney cancer - cryodestruction, radiofrequency ablation, laser ablation, high-power focused ultrasound; microwave thermoablation, chemoablation with the introduction of ethanol into the tumor and other substances. The role of these methods is being studied; it is possible that some of them will take the forefront in the treatment of a localized small tumor of the kidney.

Thus, modern technologies open new perspectives both in the diagnosis and treatment of kidney cancer.

[1], [2]

Medicinal treatment of kidney cancer

Kidney cancer is insensitive to systemic chemotherapy and hormonal treatment.

Immunotherapy plays a leading role in the treatment of common forms of kidney cancer. There are following immunotherapeutic methods of treatment of kidney cancer:

• nonspecific immunotherapy with the use of cytokines (ingerferons, interleukins) and other modifiers of biological reactions;
• adaptive cellular immunotherapy with the use of autolymphocytes (ALT), lymphokine-activated killers (LAK), tumorin-filtering lymphocytes (TIL);
• specific immunotherapy (vaccine therapy);
• gene therapy;
• mini-allogeneic stem cell transplantation.

In order to improve the quality of life of patients with cancer of the kidney with metastases in the bone, recently used drugs of the bisphosphonate group (zolendronic acid, pamidronic acid, clodronic acid, etc.). Bisphosphonates regulate the process of mineralization in the body, normalizing the level of calcium in the blood serum and promoting regression of bone metastases.