Kidney cancer: laparoscopic surgery and the latest technologies

By Cristiano Antonino On Nov 16, 2022

Adenocarcinoma, the most common form of kidney cancer, accounts for about 2% of all malignancies and mainly affects the male sex: of the 4,000 cases registered each year in our country, 2/3 are men

At what age does the tumour arise

Kidney cancer has a peak onset around the age of 60, although it is increasingly common to observe it in 40- and 50-year-olds.

This is partly due to improved diagnostic techniques and the increasing application of ultrasound, which allows detection of kidney cancer at an early stage and in asymptomatic patients, often as an occasional finding during an abdominal examination performed for other reasons.

Symptoms of kidney cancer

Kidney cancer is usually asymptomatic.

Only in advanced stages do the typical symptoms of the disease manifest themselves, i.e:

palpable mass in the abdomen
blood and clots in the urine;
localised pain in the lower back’.

There are also other non-specific symptoms that can appear in the case of kidney cancer, including:

weight loss
marked fatigue;
fever;
anaemia;
hypertension;
hypercalcaemia (a condition of increased calcium in the blood).

The different types of kidney cancer

There are different types of kidney cancer

adenocarcinoma: originates from the cells lining the internal tubules of the organ, which are responsible for filtering the blood to eliminate toxic substances and waste produced by the body;
sarcoma: rarer, it originates in different tissues, for example, in the capsule surrounding the kidney;
nephroblastoma: this is the most common cancer of the kidney in childhood.

Causes of kidney cancer

The main risk factor for kidney cancer, as for other forms of cancer, is cigarette smoking.

Other risk factors are:

being overweight;
prolonged exposure to certain metals and substances, such as lead, cadmium, phenacetin and thorium.

There are also rare forms of kidney cancer within genetic syndromes, most notably Von Recklinghausen syndrome.

How it is diagnosed

Ultrasound and CT scans are the investigations normally used to diagnose this type of tumour.

CT (Computerized Axial Tomography), in particular, in addition to helping to define the benign or malignant nature of the mass, provides information on the local extension of the tumour and on the presence and location of any metastases that originate mainly in the lung, liver, bones, more rarely in the adrenal, other kidney, brain, spleen, intestine and skin.

Magnetic resonance imaging, on the other hand, plays a very limited role in this field, and is useful in patients allergic to contrast medium and to define particular diagnostic aspects in selected cases.

From traditional to laparoscopic surgery

The therapy of kidney cancer is represented exclusively by surgery, which plays a fundamental role, both in localised and in locally advanced and metastatic forms of cancer.

In the latter case, following removal of the kidney, the patient is subjected to pharmacological therapies that are very effective today, some of which aim to activate the patient’s immune system against the cancer.

Generally, surgery involves the complete removal of the diseased kidney, the so-called radical nephrectomy.

In some cases, however, when the tumour is peripheral and not more than 4 cm in diameter, it is possible to remove only the diseased part of the organ, in which case we speak of partial nephrectomy.

In both cases, traditional surgery, known as ‘open surgery’, involves large skin incisions, leading to post-operative pain, prolonged hospitalisation and a slow, gradual resumption of social and working life.

Today, however, nephrectomy can be performed laparoscopically, i.e. with a minimally invasive technique, by accessing the abdominal cavity through 3 small holes through which, with special instruments including a miniaturised camera known as a laparoscope, the surgery is performed.

The advantages of laparoscopic surgery

This technique guarantees the same results in terms of oncological efficacy, as documented by numerous scientific publications, and has undoubted advantages for the patient

marked reduction in post-operative pain
rapid resumption of physical activity, including sports, and work in a much shorter time.
absence of abdominal scarring.

For these reasons, laparoscopic renal tumour surgery represents the first therapeutic choice for the treatment of this neoplasm, as also indicated by the guidelines of the European scientific society of urology, the European association of Urology.

Kidney cancer, 2 new technologies for even more targeted operations

The first laparoscopic kidney removal was performed in 1991 by the American surgeon Klaiman.

Since then, this minimally invasive surgical technique has spread to become routine at leading urological centres and has been implemented with new instruments using ultrasonic and radiofrequency energies.

Recently, 2 new technologies have been introduced

3D miniaturised intraoperative cameras that offer a three-dimensional view of the surgical field;
Near-infrared fluorescence using indocyanine green, a fluorescent dye administered to the patient during surgery and visualised at the kidney level, which functions inside the abdomen as a tracer that guides the surgeon during the operation.

When used together, these 2 technologies make it possible to obtain a precise topography of the renal vasculature and tumour margins, allowing the surgeon to be more precise, radical and with fewer complications.

Thanks to these technological innovations, it is now possible to use videolaparoscopic techniques to treat even renal tumours for which the use of a surgical robot was preferable in the past.

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