Urology Team Continues Focus on Improving Kidney Cancer Surgery Outcomes

Alexander Kutikov, MD, FACS

 

The urologic oncology team at Fox Chase Cancer Center continues to work with international partners to pursue optimal surgical strategies for its patients with kidney cancer. 

Last fall, Alexander Kutikov, MD, FACS, chief of the Division of Urology and Urologic Oncology at Fox Chase Cancer Center, collaborated on the publication of a study detailing how the resection technique used during partial nephrectomy might affect perioperative outcomes and surgical margins.

Now Kutikov has helped author two more publications to further tailor some of the key decisions made regarding the resection of renal masses. 

The first paper, published in European Urology, is a review examining important treatment decisions for patients with localized solid renal masses.

“Small renal masses have very nuanced decision-making wrapped around them. This was a collaborative review with leaders from around the globe trying to crystallize the key decision points and factors that go into them,” said Kutikov. “All the decision points have multiple variables that feed into them, such as patient factors, surgeon factors, and tumor factors.”

The authors identified three critical decisions that must be made for successful treatment of renal masses. The first involves surveillance versus treatment. According to Kutikov, the decision to treat a tumor at all can be very important because, in some patients, it is safer and more appropriate to just monitor the tumor closely.

If the decision is made to treat the tumor, the second key decision point is how to approach the treatment: with thermal ablation, partial nephrectomy, or radical nephrectomy. The last key decision is selecting whether to use a laparoscopic, robotic, or small-incision approach.

The second review, published in the journal Translational Andrology and Urology, dives into the indications and outcomes for different approaches to partial nephrectomy, an approach that Kutikov says requires particular expertise and critical decision making.

Kutikov said this technique can be especially difficult to perform in patients who have had previous abdominal surgery or in those who have a tumor in a challenging location. In those cases, Kutikov said an effective technique used by surgeons at Fox Chase is the retroperitoneoscopic robotic partial nephrectomy.

This technique allows surgeons to go behind the kidney and remove the tumor from a location behind the peritoneum without having to encounter scarring from a previous surgery. Kutikov said this technique allows surgeons to remove a tumor from the kidney without affecting the patient’s overall kidney function. “Most centers would use open surgery, but we have advanced this technique of retroperitoneoscopic robotic partial nephrectomy,” Kutikov said. 

“At Fox Chase, we pride ourselves on advanced surgical techniques for our patients,” Kutikov said. “This work really highlights that before someone comes to surgery, they need to see experts who understand the biology and the natural history of disease to make sure surgery is really the right answer for them.”