Standard at T1a
Small tumors are usually detected by chance during ultrasound and in 20–30% they turn out to be benign (oncocytoma, angiomyolipoma) - resection with histology provides an accurate diagnosis and treatment at the same time. Laparoscopically, the renal artery is clamped for 10–20 minutes (or resection is performed without clamping for exophytic tumors), the tumor is excised, and the bed is sutured with a continuous suture with a hemostatic sponge. The drug is removed in a container. The drainage is removed after 2–3 days, discharge on the 4th day, back to work after 3 weeks.
Why save a kidney?
For tumors up to 4 cm (T1a) and in many cases up to 7 cm, partial nephrectomy gives the same oncological result as removing the entire kidney, but preserves function - this reduces the risk of chronic kidney disease, cardiovascular complications and is important for a solitary kidney, bilateral tumors, diabetes and hypertension. Current standards recommend resection for all tumors where it is technically feasible.
Difficulty categories and access
In the price list, resection is divided by tumor size: up to 4 cm, 4–7 cm, more than 7 cm - the larger and deeper the tumor, the more difficult the kidney reconstruction and the longer the ischemia. Laparoscopic resection is the standard for peripheral and exophytic tumors; open is performed for central, multiple tumors, a single kidney and complex anatomy, when tactile control and minimal ischemia time are needed.
Results
Local recurrence after resection is 2–5%, 5-year survival rate for T1 is 90–95%. The function of the operated kidney decreases slightly if ischemia does not exceed 20–25 minutes. The main complications are bleeding and urinary drip (3–5%), which are controlled by drainage and, if necessary, embolization or a stent.
