By Dr Manav Suryavanshi
Renal cell carcinoma (RCC) accounts for two to three per cent of all adult malignant neoplasms and is the most lethal of the common urologic cancers. It occurs within the age range of 55 to 75 years. The incidence of RCC has increased due to the routine use of ultrasonography. This rising mortality rate is worrisome, as the proportion of advanced tumours has decreased due to early diagnosis. This condition may be associated with factors such as tobacco use, dietary habits, obesity, or exposure to other cancer-causing substances. In men, 20 per cent to 30 per cent of cases of RCC are caused by tobacco use, while in women, it accounts for 10 per cent to 20 per cent of cases. Obesity is also widely recognised as a significant risk factor. Hypertension is the third leading factor, as it can cause kidney damage and make the kidneys more susceptible to cancer-causing agents. Having a family history of RCC, end-stage renal disease, or regular use of non-steroidal anti-inflammatory drugs (NSAIDs) also increases the vulnerability to RCC.
A significant number of kidney masses do not cause symptoms and are often discovered incidentally during routine ultrasound screenings, accounting for over 60 per cent of cases. Symptoms can arise from local tumour growth, bleeding, paraneoplastic syndromes, or the spread of cancer to other parts of the body.
Preventive measures for kidney cancer include adopting a healthy lifestyle and quitting smoking. A well-balanced diet that includes ample fruits, vegetables, whole grains, and lean proteins, while minimising processed food intake, can help maintain a healthy weight, thereby reducing the risk of kidney cancer. Sufficient hydration by drinking an appropriate amount of water can help prevent kidney stone formation, indirectly reducing the likelihood of kidney cancer associated with long-term kidney stones. Managing blood pressure and diabetes through medications, lifestyle modifications, and regular medical check-ups can also contribute to lowering the risk. Furthermore, minimising exposure to hazardous substances such as asbestos, cadmium, and organic solvents in the workplace may also reduce the risk of kidney cancer.
Surgery remains the primary treatment for localised kidney cancer. Depending on the stage and size of the tumour, partial or complete removal of the affected kidney (nephrectomy) may be recommended. Minimally invasive techniques like robot-assisted surgery offer reduced recovery times and improved outcomes. Surgical interventions aim to remove the tumour while preserving kidney function whenever possible.
Robotic surgery has become popular in recent times as it combines the precision of minimally invasive techniques with the advanced capabilities of robotic technology. The urologist controls the robot, which translates his movements into precise and scaled actions, allowing for enhanced dexterity and visualisation during the procedure.
Robotic surgery provides several benefits when compared to traditional open surgery or conventional laparoscopy. These advantages include enhanced surgical precision and minimised trauma due to smaller incisions, resulting in reduced pain and blood loss. Patients undergoing robotic surgery often experience quicker recovery times compared to those undergoing open surgery. The improved manoeuvrability of robotic surgical systems enables the preservation of the healthy portions of the kidney during tumour removal, thereby helping to maintain kidney function. Additionally, the smaller incisions used in robotic surgery have the added benefit of being aesthetically pleasing from a cosmetic standpoint.
It is important to note that not all kidney tumours are suitable for robotic surgery, and the decision on the appropriate surgical approach should be made in consultation with a urologic surgeon.
In cases of advanced kidney cancer, medical oncologists may recommend targeted therapies and immunotherapy drugs as part of the treatment plan. These medications work by targeting specific molecules or boosting the immune system to fight cancer cells effectively.
In conclusion, robotic surgery has emerged as an effective and minimally invasive approach for the management of localised kidney cancer. The procedure’s precision, reduced trauma, shorter recovery times, and preservation of kidney function make it an attractive option for eligible patients, along with improved patient outcomes and quality of life.
(The author is the Head, Department of Urology, Section Incharge – Uro-Oncology & Robotic Surgery, Amrita Hospital, Faridabad)
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