Kidney Cancer - Treatment

Surgical treatment of kidney cancer is the main method of treating kidney cancer. Radical nephrectomy is most often performed.

There are a number of indications for nephrectomy.

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

In the presence of metastases in regional lymph nodes, lymphadenectomy is mandatory.

Lymph node dissection in the treatment of kidney cancer is performed for the following purposes: determining the stage of the process; preventing local recurrence; increasing survival.

Lymph node dissection for renal cancer involves removal of all fatty tissue with lymph nodes surrounding the ipsilateral main vessels, from the level of the crura of the diaphragm immediately below the level of the superior mesenteric artery to the bifurcation of the aorta and inferior vena cava.

Improved diagnostic methods have led to the fact that the detected kidney cancer is often small in size and limited within the organ. Localized kidney tumor is a neoplasm of stage T1a, T1b and T2. If the size of the kidney cancer is no more than 3-5 cm, it is possible to perform an organ-preserving operation (resection of the kidney).

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

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

• bilateral synchronous and asynchronous renal cancer;
• cancer of an anatomically or functionally solitary kidney;
• cancer of one kidney and damage to the other by a non-oncological process, as a result of which the organ undergoes significant changes and cannot ensure the vital functions of the body.

A relative indication is cancer of one kidney and insufficiency of the other with mild renal failure.

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

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

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

In the last 10 years, thanks to the improvement of special instruments and the skills of doctors, laparoscopic kidney surgery has become an effective and less traumatic alternative to open radical nephrectomy in a certain group of patients. The first laparoscopic nephrectomy for kidney cancer was performed in 1990 by R. Kleiman. Currently, laparoscopic nephrectomy is widely used for kidney cancer. Compared to open surgery, it reduces postoperative pain, as well as the length of the patient's stay in the hospital and the period of his recovery after the operation.

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

In patients with kidney cancer who underwent laparoscopic surgery, five-year survival results are comparable to those after open surgery.

Recently, there have been reports from domestic authors about the use of laparoscopic access in kidney cancer. We are talking specifically about laparoscopic access, and not about laparoscopic surgery, since the technique of the surgical intervention itself does not differ from the standard one when using the transperitoneal surgical approach.

If resection of a renal neoplasm is impossible (severe intercurrent background, old age, small size of the neoplasm or unwillingness of the patient), then one of the options of minimally invasive surgery of kidney cancer can be chosen - cryodestruction, radiofrequency ablation, laser ablation, focused high-power ultrasound exposure; microwave thermal ablation, chemoablation with the introduction of ethanol and other substances into the tumor. The role of these methods is being studied; it is possible that some of them will take leading positions in the treatment of localized small kidney tumors.

Thus, modern technologies open up new perspectives in both diagnostics and treatment of kidney cancer.

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Drug treatment for kidney cancer

Kidney cancer is resistant to systemic chemotherapy and hormonal treatment.

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

• non-specific immunotherapy using cytokines (interferons, interleukins) and other biological response modifiers;
• adaptive cellular immunotherapy using autolymphocytes (ALT), lymphokine-activated killers (LAK), tumor-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 kidney cancer with bone metastases, drugs of the bisphosphonate group (zoledronic acid, pamidronic acid, clodronic acid, etc.) have recently been actively used. Bisphosphonates regulate the mineralization process in the body, normalizing the level of calcium in the blood serum and promoting the regression of bone metastases.