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USC urologists are acknowledged world leaders in advanced laparoscopic and robotic minimally invasive surgery for kidney cancer. Specifically, our surgeons have the world’s largest experience with minimally invasive kidney-sparing surgery, including robotic and laparoscopic partial nephrectomy and renal cryoablation. Our aggregate experience with robotic, laparoscopic, percutaneous and open surgery for all types of kidney cancer exceeds 3,000 clinical cases, which is amongst the largest in the world.
USC urologists have pioneered, refined and popularized advanced techniques of laparoscopic and robotic partial nephrectomyPartial Nephrectomyremoval of diseased part of the kidney while sparing the healthy part for kidney cancer. We have performed this technique in over 1,200 patients, which is by far the world’s single-largest experience. Our team has published definitive data on excellent cancer cure outcomes and superior preservation of kidney function with low complication rates after laparoscopic and robotic partial nephrectomy.
In January 2010, in the Journal of Urology (2010; 183:34), we published the world’s largest single-surgeon experience with laparoscopic partial nephrectomy involving 800 patients with kidney tumors. Our ischemia times are the amongst the lowest in the field, therefore we produce excellent kidney functional outcomes. This means our patients not only can beat the cancer, but also have a good chance of saving their kidney.
In February 2010, in the New England Journal of Medicine (2010; 362: 624), we published a manuscript titled “Small Renal Mass.” This is a succinct and expert overview of the current state of knowledge, highlighting the latest diagnostic tests and treatment outcomes.
In March 2010, in the Journal of Urology (2010; 183: 889), we presented the world’s largest follow-up data of up to 11 years following laparoscopic renal cryoablation in over 80 patients. Cryoablation is a technique for freeze-destroying kidney tumors in patients who are not candidates for laparoscopic partial nephrectomy.
Also in 2010, long-term outcomes of 2,246 patients undergoing laparoscopic or open partial nephrectomy for a single renal tumor 7 cm or less were reported in the Journal of Urology (2010; 183: 473) in collaboration with Cleveland Clinic. Cancer recurred infrequently and only rarely caused mortality after laparoscopic or open partial nephrectomy. Cancer outcomes at 7 years after laparoscopic and open partial nephrectomy were excellent with the majority (97%) of patients experiencing metastasis-free survival.
Our team has helped expand the indications of laparoscopic radical nephrectomy to include well-selected patients with more advanced kidney tumors, such as tumors larger than 10-15cm, tumors locally invading the peri-renal fat, tumors with renal vein thrombus (Level I) and limited vena cava involvement (Level II) and presence of loco-regional enlarged lymph nodes. We recently reported the longest follow-up data in patients undergoing laparoscopic radical nephrectomy for cancer up to 10 years in the Journal of Urology (2009;182: 2172).
USC surgeons also the world’s largest experience with upper tract transitional cell carcinoma managed with minimally invasive techniques. In the Journal of Urology (2008;180:849—link to library),we reported long-term outcomes in the largest group of patients (n=100) undergoing laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma.
Our team has extensive experience in the management of the most advanced kidney cancers, in particular tumors with involvement of the vena cava (caval tumor thrombus). These are some of the most challenging surgical cases in urology and require significant experience and expertise for optimal outcomes. We have described our techniques and results in several academic publications and have one of the largest series in the country. In particular, our surgical approach avoids cardiopulmonary bypass and circulatory arrest in all cases except for those involving the right atrium. This avoids the neurologic and bleeding complications of hypothermia with circulatory arrest. In addition we have described the technique of vena cavoscopy to assess residual disease within the caval wall by direct visualization.
We strongly believe in spending ample time with patients and their family in order to discuss their cancer diagnosis and treatment options. Family support is very important when making major treatment decisions. Cancer staging systems are explained using anatomic diagrams as well as the patients own radiological studies to show the extent of the disease and what surgical approach is used to eradicate the cancer. We believe that patient understanding of all aspects of their treatment is key to successful outcomes. It is crucial that patients also understand the complication rates and side effects for each procedure or treatment in order to make an informed decision.
