Jeffrey Cadeddu, M.D. Answers Questions On: Kidney Cancer

Almost 80 percent of kidney cancers are stage 1 disease. In those patients, the standard of care has shifted toward partial nephrectomy, rather than removing the entire kidney. It’s technically challenging to do, but the reason we try to save as much of the kidney as possible with partial nephrectomies or ablations is that data indicate taking out the whole kidney for small cancers is overkill. And, in fact, patients who have 1½ or more kidneys live longer than patients who only have one.

It’s the same thing as single incision surgery. It’s a term used in Europe. Basically, we go through your belly button – through a small keyhole – and do the entire surgery without any extra holes, and there are no visible scars. We can do single incision surgery to remove a kidney, repair a blockage, or remove an adrenal gland. But we can’t remove partial kidneys through a single incision – at least not yet – because that’s a very complex operation.

One treatment of ablation will be sufficient to remove a tumor more than 93 percent of the time. The size of the tumor and your own personal anatomy are the biggest factors in determining if you can have ablation rather than surgery. Sometimes age is a factor. The success rate of surgery is a little bit higher than ablation – about 99 percent – so with the younger patient we’ll often do surgery just to have the maximum amount of success. Ablation is not offered to every patient, but it’s always part of the discussion.

My biggest frustration is that there are patients who are misinformed and undergoing treatments that are overly aggressive where their doctor takes the whole kidney out, or they have open surgery when they could have had a minimally invasive procedure. You hear of patients all the time who had big open surgeries or had a kidney taken out, and you know they could have done better here at UT Southwestern.