Treatment of kidney tumours
If the growth of the kidney tumour is limited to the kidneys, various surgical techniques are available.
The treatment is selected on the basis of individual patient- and tumour-related factors.
Nephrectomy / Tumour nephrectomy
Where the kidney affected by the tumour cannot be preserved for pathological (risk of tumour recurrence) and/or functional (kidney completely infiltrated by the tumour) reasons, a tumour nephrectomy is performed (including adipose capsule and lymph nodes).
For this purpose, the University Department of Urology Tübingen uses minimally invasive (laparoscopic) or open surgical techniques.
Laparoscopic surgery (“keyhole surgery”) allows for kidney tumours to be resected gently depending on their location and size. The prerequisites for laparoscopic surgery can be adversely affected by concomitant circumstances, such as previous abdominal surgeries and other concomitant diseases. The benefits of minimally invasive laparoscopic surgery include, in particular, reduced length of hospital stay, faster postoperative recovery and an appealing cosmetic result.
Open surgery may be required if concomitant diseases do not permit the use of laparoscopy, in the event of particularly large tumours invading neighbouring organs or if the large abdominal blood vessels are affected by so-called tumour thrombi. In isolated cases, kidney tumours can infiltrate the veins and even extend into the inferior caval vein, which is referred to as caval thrombosis. Being a tertiary-care department, we also operate on patients at such advanced tumour stages.
Partial nephrectomy: Organ preservation in kidney tumours
Current therapy guidelines stipulate open partial nephrectomy as the standard technique for the treatment of organ-confined kidney tumours. In particular in the event of single kidneys, bilateral tumours and existing renal insufficiency, nephron-sparing therapy is urgently indicated.
At centres with corresponding experience, including University Hospital Tübingen, minimally invasive, laparoscopic partial nephrectomy (keyhole surgery) has been developed to become a therapeutic alternative. Today, the vast majority of kidney tumours can usually be removed while preserving the residual tissue of the healthy kidney and removal of the entire kidney is only necessary in exceptional cases.
At the time the diagnosis is established, about one-third of the patients have already developed lymph node and/or organ metastases (mostly in the lungs, the bones and the lymph nodes).
In cases where the metastases cannot be removed surgically, medication is required to prevent the development of new blood vessels that supply the tumour with nutrients for growth. These so-called tyrosine kinase inhibitors or mTOR inhibitors are used successfully in the treatment of renal cell carcinoma metastases.
A major advantage of these medicines is that they can be administered orally, i.e. in the form of tablets.