Removal of kidney tumour via keyhole surgery is a better option
A 46-year-old man visited the outpatient clinic of International Modern Hospital (IMH), with non-specific lower urinary tract symptoms.
On routine ultrasound for his long-standing symptoms, a 2cm left renal mass was incidentally detected. Subsequent triple phase CT scan confirmed radiological features to be consistent with cancer of the kidney.
Small renal masses are being commonly found following widespread use of ultrasound of abdomen for unrelated symptoms — 20 per cent may be non-cancerous, while 80 per cent tend to be due to renal cancer; 20 per cent of these could be aggressive renal cell cancer.
Options of treatment include monitoring over a period of time with repeated imaging to see if there is interval increase in size; or, excision of these lesions for biopsy confirmation. Biopsy has been recommended in the select group, but one to two per cent false negative reporting can cause false reassurance to the patient.
In the past, many patients underwent complete removal of the affected kidney for complete cure. It was later discovered that this form of treatment was overkill, and resulted in a longterm decrease in kidney function, especially if there were associated co-morbid conditions, such as diabetes and hypertension. Moreover, with improvement in technical advancement, it is now possible to remove tumour alone with adequate margin and preservation of rest of the kidney using keyhole surgery.
Keyhole surgery is technically challenging, takes longer than complete removal of the kidney, and can cause bleeding at the time of surgery, therefore, should be undertaken in centres with good infrastructure and adequate backup facility.
The patient waited for more than two months, getting second opinions from various centres and decided to undergo laparoscopic partial removal of his left kidney tumour. Surgery was carried out through keyhole technique and patient made a good recovery. He was fit for discharge from the hospital on the fourth day.
Biopsy of removed specimen confirmed this lesion to be renal cell cancer and all margins of resection were clear of tumour, potentially curing him of cancer. Of course, he is on regular follow up as per protocol, but early intervention and safe removal of tumour, preserving normal part of kidney compare well with recommended international standards of treatment as practiced to this day.
“Partial Nephrectomy is not an easy job because it involves taking control of the blood supply and make sure that the whole kidney is alive and at the same time remove a part of the kidney,” said D Rohit Kumar, specialist general surgeon, head of surgery and emergency, and medical director at IMH.
Commenting on this complex and challenging case, Dr Kishan Pakkal, CEO of IMH, said: “We encourage our doctors to take up complex and critical cases which in turn enable exceptional patient outcomes.”