What you need to learn about your surgeon’s experience and more before deciding where to seek cancer care.
When you are diagnosed with kidney cancer, it's crucial to make sure your team is taking the right steps with your treatment, especially with regard to surgery — whether you really need it, what type of surgery is best for you, and whether your doctors have the skill and experience required to remove your cancer while preserving as much kidney function as possible.
"Surgery is the gold standard of care. It's the preferred method for those healthy enough for it, and a vast majority of patients will undergo surgery. It provides you with the lowest rates of recurrence and is your best chance to be cancer-free," says urologist Eric Kauffman, MD, who specializes in treating kidney cancer at Roswell Park Comprehensive Cancer Center. "You want a surgeon and a treatment center with the skills and expertise for your best outcomes. Urologists are trained surgeons and most treat a wide range of urologic diseases and conditions. But at Roswell Park, our urologists focus on cancer."
Do I really need to have surgery?
Depending on the size of your tumor, surgery may not be your best option. For those with small, slow-growing tumors, active surveillance, or "watchful waiting," might be the best option.
With active surveillance, your physician team monitors your kidney tumor closely to delay or perhaps avoid treatment altogether. This means you can delay or avoid side effects from surgery. The evidence-based plan involves periodic radiographic imaging with CT or MRI scans and the possible use of biopsy. Radiographic monitoring requires expertise in recognizing subtle "red flag" changes. Biopsy of small kidney tumors is technically challenging and requires someone with high expertise.
"We are among the leaders in active surveillance with about 500 patients currently being monitored, while many community practices might have fewer than a dozen," says Dr. Kauffman. He adds that only 25% of patients will require treatment within five years of being watched.
"Our radiologists see enough patients where they can tell when the smallest bit of growth is cause for concern. Something as small as 0.2 or 0.3 cm may not seem like a lot, but it can be a red flag. Our team will catch that growth and we'll know if you need to move forward with treatment. Our interventional radiology staff will be able to target the tumor with a biopsy accurately and our experienced pathologists can use this biopsy tissue to accurately identify the subtype of kidney tumor that a patient may have. This includes being able to tell whether it's benign or cancerous, and if the latter, whether it's likely to be aggressive or slow-growing."
Can you just remove the cancer rather than my whole kidney?
Humans can live with one kidney and for that reason, many surgeons will remove the entire kidney that's affected by cancer in a procedure called radical nephrectomy. But that's not always best for the patient.
"Preserving kidney function is key," Dr. Kauffman stresses. Kidney function is tied to your heart and overall health by filtering waste from your body, regulating blood pressure, helping produce red blood cells and more. Your kidney function naturally declines as you age, so it's in your best interest to maximize kidney function by keeping as much of your kidney as possible at all costs.
Removing only the cancer from the kidney, called a partial nephrectomy, may be better for your long-term health. "This can often be a complicated surgery which requires your surgeon to have a higher level of skill and experience," he says.
Roswell Park is a leader in this delicate, skill-intensive surgery and performs more partial nephrectomies than any other provider in the state outside of New York City.
"We will always attempt to do whatever is possible to save the kidney. We often perform partial nephrectomy on more complicated tumors, where others might find it easier just to remove the whole kidney."
Dr. Kauffman estimates that for 98-99% of patients with tumors smaller than 4 cm, surgery will remove your cancer entirely.
Thermal ablation is often the next line of treatment if the tumor is small, but surgery is not feasible, or if an operation you previously had was not curative. If you are not eligible for surgery, there may also be options for immunotherapy or clinical trials.
How many surgeries have you performed?
A surgeon's experience from performing a large number of surgeries matters. You want to seek care from a cancer center that's considered a high-volume center. Regarding nephrectomies, that's defined as more than 50 surgeries a year. In 2022, Roswell Park's urologists performed more than 90.
Dr. Kauffman has personally performed more than 300 kidney surgeries at Roswell Park and stresses that with his experience and his colleagues' experience comes clear advantages to the patient.
Do you perform robotic surgery for this operation?
Roswell Park's surgeons are skilled in both robotic techniques and traditional open surgery.
"The operations we do are about 50/50: open surgery or robotic," states Dr. Kauffman. "When it comes down to a partial nephrectomy, most of those are done robotically. This allows for smaller incisions and quicker recovery."
"There are advantages to both types of surgery. We are unique at Roswell Park, where our urologists perform a high number of both types. The best one for you will depend on the size and position of your tumor, as well as your kidney health and overall health," says Dr. Kauffman. "Your surgeon will ensure the approach they take is the best decision for you."
Why should I come to an NCI-designated cancer center?
While having an experienced surgeon is crucial, sometimes it's just as important to have an equally experienced team when surgery is not involved. You get that at Roswell Park, where we excel in multidisciplinary care, having so many experts under one roof.
In addition to surgeons trying to preserve kidney function, doctors also work with interventional radiologists and pathologists, sitting on a tumor board to decide the next steps in a patient's treatment plan. Sometimes, our experts consult cardiovascular surgeons, liver specialists and even our nutrition team to create a special renal (kidney) diet.
"Our whole team plays a role in patient care," says Dr. Kauffman.
Why Roswell Park for kidney cancer?
Find out more about what makes Roswell Park unique in treating kidney cancer.
