Introduction

Currently, surgery offers the only well-recognized chance of cure from kidney cancer. The principal developments in renal cancer surgery in recent years relate to the use of laparoscopy and it is likely that the scope of minimal access surgery will continue to increase in the future. In this chapter, we give an overview of the indications and current status of both open and laparoscopic techniques of radical and partial nephrectomy, as well as surgery for metastatic disease.

Radical nephrectomy (RN)

Surgery has been the mainstay of treatment of renal cell carcinoma (RCC) for over 35 years and remains the only curative therapeutic approach. In 1969, Robson et al. described their results from radical nephrectomy in a series of 88 patients with RCC. The original operation involved early ligation of renal vessels to avoid tumor embolization, adrenalectomy, removal of perirenal fat, and extensive lymph node dissection from the crus of the diaphragm to the bifurcation of the aorta. This approach was described in a time when diagnosis was often made on the basis of intravenous urography (IVU) or angiography. Accurate preoperative anatomical definition was not possible and the tumor was often of an advanced stage at operation. Recently, with the increased sensitivity of imaging and high resolution computerized tomography (CT) scans the exact anatomy of the tumor can be confidently mapped prior to surgery.