Minimally Invasive Kidney Surgery: Emerging Oncological Concerns

Minimally invasive kidney tumor surgery has evolved over the last 33 years beginning with laparoscopic radical and later partial nephrectomy and with more recent progression to robotic assisted laparoscopic operations. The principal advantages of minimally invasive surgery (MIS), also reported widely in other surgical specialties, include less painful and more cosmetic incisions and faster return to normal activities and work when compared to similar open surgical operations. In addition, reports of oncological outcomes that were noninferior to similar open surgical operations led to worldwide expansion of these approaches. However, from the earliest experience with MIS utilized in oncological surgery to the present, reports of atypical tumor recurrences (ATR) in locations not usually part of the natural history of a specific cancer, including port sites, tumor resection beds, and carcinomatosis, raised concerns amongst surgeons and oncologists in many specialties. Surgeons performing MIS techniques for kidney tumors reported similar ATR. Although ATR is an uncommon clinical event, the impact on the individual patient who experiences it usually leads to a heavy treatment burden of surgical salvage with or without additional systemic therapies and a low likelihood of complete remission. The mechanisms by which ATR occur and its precise incidence are unknown, but a more complete understanding of its etiology and means of prevention is currently an unmet research need. Surgeons in Europe and the United State have taken initial steps to coordinate consortium data to address aspects of this serious surgical problem.