Kidney cancer: the advice of the specialist doctor

Interview with Dr. Morgan Rouprêt, urologist surgeon , hospital-university practitioner at the Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris.

What is the benefit of anti-angiogenic drugs over immunotherapy?

It is true that, in the case of metastatic kidney cancer, the only response in recent years was immunotherapy. Clearly, the patient's immune defenses were strengthened by using interferon alpha and inteleukin 2. These products have a toxic effect on the cancer cells. That said, the side effects were important and the failures numerous: the effectiveness of these treatments is limited to about 5%. This is why we now use anti-angiogenic treatments for metastatic cancer. They have the effect of closing the neo-vessels and thus "starve" the cancerous tumor that eventually destroys itself and disappear. And the stakes are high, since kidney cancers are often diagnosed when they are metastasized.

Has the management of kidney cancer evolved?

It remains a heavy cancer with a random prognosis. Especially since he is diagnosed often late. There is still no organized screening for this cancer. What has evolved, apart from the management of metastases, are the operative techniques. Minimally invasive, laparoscopic operations greatly improve patient comfort. His recovery is much faster. His shorter hospital stay: three to four days, instead of fifteen days, for a laparotomy, a classic operation.

And the operation with robots, does it really change the situation or is it anecdotal?

It's not anecdotal at all. With this robotic system of surgical telemanipulation, the surgeon has a magnified vision and 3 dimensions of the area to operate. He can make gestures, through robots, that he could hardly do before. This goes in the direction of the least invasive surgery possible.

The surgeon will always try to preserve part of the kidney, if it seems reasonable. Preserving a little healthy parenchyma is to preserve the patient from kidney failure. And for people who already have only one kidney, this is the only hope. Robot assisted interventions are therefore very promising.

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