Very non-invasive techniques, main allies in the fight against kidney cancer

2-3% of malignant cancers are kidney cancers, according to data from the Spanish Society of Medical Oncology (SEOM); a pathology twice as common among men, and whose diagnosis is usually more common after the age of 50. Currently, the standard treatment is surgery, which has become minimally invasive, through laparoscopy, and with evolution towards robotics, providing numerous advantages not only when it comes to overcoming the disease, but also for a better and faster recovery. patient.

This is stated by Dr. Antonio Alcaraz, a specialist in Urology at the Teknon Medical Center of Barcelonabelonging to the Quirónsalud group, an expert in these techniques and who also highlights that laparoscopy “has been a before and after” in kidney surgery, implemented in our country at the beginning of this century, as well as “a great advance in recovery of the patient, and without compromising the oncological result.”

In turn, this urologist highlights that robotic surgery has shortened the learning curve, and “makes this minimally invasive surgery more accessible” to new generations of urologists. “The current trend is to remove the tumor with a margin of healthy tissue, reserving radical nephrectomy (removing the entire kidney) for the most voluminous cases. Kidney surgery requires a long training process,” he adds.

Candidates for minimally invasive surgery

“How do you decide if a patient is a candidate for a minimally invasive procedure or not? It’s simple. If you can technically perform the procedure without compromising the oncological result, you should do a minimally invasive technique. It depends largely on the experience of the surgeon,” warns Dr. Alcaraz.

In his opinion, “there is no doubt” that the robotic technique will end up prevailing over any other procedure since, although laparoscopic surgery is just as effective and minimally invasive, it requires extensive experience. “Those of us who have it can operate with both tools. The new generations have shortened their learning curve with the use of robots. Both, in the right hands, are ideal,” he insists.

Along these lines, the Teknon Medical Center specialist maintains that the most important challenge of kidney surgery is to prevent bleeding: “Approximately one liter of blood passes through a kidney per minute, so it is essential to avoid injuries with the potential for hemorrhage. In partial nephrectomies (where we preserve most of the kidney) it is usually necessary to close the blood circulation in the kidney. “This has a time limit, which ranges between 30-40 minutes, after which irreversible damage to kidney function will occur.”

Advantages of advanced surgical techniques

With all this, this expert defends that the traditional open technique is still used in large renal masses, those that do not allow safe manipulation during surgery. However, he assures that there has been an extension of the indications for minimally invasive surgery, even in extreme cases, such as the extension of tumor thrombi within the vena cava. “The capacity for improvement seems to have no limit,” he asserts.

Scientific advances

The robotic technique is prevailing over any other procedure

Among the most common complications after kidney surgery, Alcaraz points out that the most feared complication is bleeding both intraoperatively and postoperatively. “The great urological surgeons tend to be kidney surgeons,” considers this specialist.

How to achieve the diagnosis

Specifically, this expert from the Teknon Medical Center highlights that solid tumors, such as kidney cancer, usually base their diagnosis on imaging tests. “Most of this type of cancer is diagnosed incidentally, by ultrasound, and its study is completed by an abdominal CT scan.”

Likewise, it maintains that 80% of kidney tumors are diagnosed in the localized phase, while the cure in this phase ranges between 70-95% of cases, depending on the aggressiveness of the tumor.”

Targeted therapies and immunotherapy

Along these lines, this expert praises the incorporation of targeted therapies and immunotherapy in recent years for the treatment of kidney cancer. “Disseminated disease bases its treatment on systemic therapies. The first to arrive were targeted therapies (tyrosine kinase inhibitors) and, later, systemic immunotherapies were added. With the use of a combination of these treatments, the survival of metastatic disease has tripled.”

Precisely, the urologist at Teknon Medical Center values ​​that the targeted therapy used in kidney cancer is that directed at the FEV-HIF axis, tyrosine kinase inhibitors, responsible for blocking the progression pathway and delaying the evolution of the tumors. “Metastatic patients with a good prognosis benefit,” he adds.

Regarding the effectiveness of targeted therapies in advanced kidney cancer, it indicates that targeted therapies are usually used in combination with immunotherapy or progression of immunotherapy. “At the very least, they delay progression and also significantly increase survival,” he highlights.

Effective techniques

Immunotherapy represents a “qualitative change” in the treatment of patients with metastatic cancer

In his opinion, and “definitely”, immunotherapy has meant a “qualitative change” in the management of metastatic cancer, being the standard (the combination of two immunotherapy treatments) in kidney cancer with an intermediate or poor prognosis. “This has tripled the survival of these patients,” he adds.

In this context, Dr. Alcaraz recalls that the partial loss of kidney function has a relative short-term impact on the patient, “little beyond an increase in fatigue”; However, the medium-term impact of poor kidney function leads to the development of cardiovascular problems and a shortened survival.

“The total loss of kidney function leads the patient to dialysis, with a significant impact on quality of life and vital risks in both the short and long term. The transplant is the best solution to this situation when we consider it feasible,” concludes the Teknon Medical Center specialist.