By Dr.Nitesh Jain
Kidneys are the chief organs of excretion, which filters our blood and remove excess salt, water, and waste from our body. They kidneys are the pair of bean-shaped organs located on either side of the spine, protected by the lower ribcage.
In spite of us having two kidneys, a good part of one kidney or a normally functioning single kidney is sometimes enough to preserve the renal functions.
As we age our kidney function tends to fall, due to aging or disease we acquire like Diabetes Mellitus, Blood Pressure. So preserving as much of kidney tissue as possible is sometimes critical to maintaining the function or preventing this patient going in for an end-stage renal disease. Renal cell carcinoma (RCC) is the most common type of kidney cancer.
The cancerous cells typically develop in the lining of very small tubes in the kidney, called tubules. Over time, these cells may grow into a mass and cause an obstruction. Cancer may form in one or both of the kidneys. Kidney cancer accounts for 3% of the adult solid tumor of this 40% are incidentally detected now a day.
They are commonly seen in 5th to 6th decade of life, but no age is spared and of late, more and more, younger patients are being diagnosed with Kidney Cancer. Many of these tumors are being picked up incidentally during a routine health checkup or while evaluating for some other ailments. One of the common symptoms of the disease is blood in the urine, but the patient may present with flank pain, lump in the abdomen.
As most of the renal tumors are being picked incidentally, they are usually small and do not warrant complete removal of the kidney ( Radical Nephrectomy). Depending on the size and location many of this tumor can be treated by partially removing the kidney (Partial Nephrectomy) by minimally invasive ways (Key Hole ie Laparoscopic or Robotic Surgery)
The advantage of removing a part of the kidney rather than complete is that this patient are more prone to get similar tumor in the opposite kidney, or if the patient is suffering from the diseases which can affect the opposite kidney in future like diabetes mellitus, hypertension, recurrent renal stone formers can save the patient from progressing to the renal failure. Or if the patient is already having mild renal failure can prevent or delay him from becoming dialysis dependent or a candidate of the kidney transplant.
According to Dr. Nitesh Jain, Consultant Laparoscopic and Robotic Urologist at Apollo Hospitals, Chennai says Partial Nephrectomy is the gold standard of treatment for renal tumor if it can be removed with good oncological clearance and safety. Removing a part of the kidney in the past was done by open surgical technique but with the advent of advancement in the minimally invasive technique, this surgery is more commonly done by a minimally invasive method like Laparoscopic or Robotic surgery. The main advantages of this keyhole surgery are less pain, shorter hospital stay, early return to the work and better cosmesis. With Robotics there is better magnification which adds to a better precision which positively affects the outcome of the surgery.
Most of the large clinical trials have shown a clear advantage of removing a part of the kidney rather than the whole, thus partial Nephrectomy has become standard of care for small, localized kidney tumor which is anatomically amenable for Partial Nephrectomy. But before performing partial removal of kidney patient should agree and be willing for a more stringent follow up than that for a radical Nephrectomy.
So an expert opinion is a must before undergoing a surgery for kidney cancer as this can save a vital part of the organ, which can prevent many dreaded complications of removing the whole kidney in many marginal patients.
Dr Nitesh Jain
Consultant Endoscopic, Lapraroscopic and Robotic Urologist,
21, Greams Road
Chennai (TamilNadu , India)