Renal cell carcinoma: modern surgical approach.

Abstract

In the past decade, minimally invasive therapy options for renal cell carcinoma have been devised in an attempt to minimize operative morbidity while achieving comparable oncologic and functional outcomes. Herein, we evaluate the new developments related to the modern surgical and energy ablative techniques for renal cell carcinoma. When compared with the open counterpart, laparoscopic radical and partial nephrectomies have equivalent operative time, decreased blood loss, superior recovery, and improved cosmesis. Nowadays, laparoscopic radical nephrectomy can be performed for pT2 tumors (up to 15 cm), and level I renal vein thrombus is not a formal contraindication for the laparoscopic procedure. Ongoing advances in laparoscopic techniques and operator skills have allowed the development of a reliable technique of laparoscopic partial nephrectomy, which includes the ability to achieve effective intracorporeal renal hypothermia. Cryoablation and radiofrequency ablation therapies have been performed through a laparoscopic or percutaneous approach, using a combination of fine probes and high-resolution imaging studies to precisely target the lesions and accurately monitor the freezing or heating ablation process. Noninvasive tumor ablation can now be achieved by extracorporeally induced high-intensity focused ultrasound. These minimally invasive techniques represent the modern surgical approach for renal cell carcinoma, aiming to decrease patient morbidity. Laparoscopic radical and partial nephrectomy techniques duplicate the open approach. Results obtained with energy ablative techniques are encouraging. Based on the known slow growth rates of small renal cell carcinoma, one should be cautious when interpreting the short-term results of energy ablative therapies monitored by imaging only.