Michael Staehler is a urological oncologist at the University of Munich. He shares his unique perspective on partial nephrectomy and why it’s so important to how he treats kidney cancer patients.
Sometimes patients express concern about partial nephrectomy – because they feel like removing the whole kidney will make them safer from cancer. But I have a different perspective that I try to share with them.
I guess you could say surgery is in my blood. My grandfather was a urological surgeon and so was my father. During his practice, my father became a big proponent of surgery dedicated to preserving kidney function. He pioneered techniques that are still used today.
The concept of a partial nephrectomy developed out of a need – we call it imperative indication. These were patients who had a renal tumor but had either only one kidney or severely impaired renal function. Surgical techniques were developed to remove the tumor but still try to prevent patients from having to go on dialysis. Overtime, we realized that in addition to saving kidney function, these patients also fared just as well when it came to their cancer prognosis.
Early in my career, I worked as part of a kidney transplantation team. I saw firsthand how hard patients and doctors fight to restore kidney function. When kidneys are failing, nephrologists fight to keep every nephron functioning. That experience, as well as the influence of my father, has made me think differently when I look at a renal tumor.
In my practice, I’ve focused on techniques to make surgery safer with reduced complications and today I almost don’t see any limitations to doing a partial nephrectomy. It’s not size or location – it’s just about how much functioning kidney you can preserve while safely removing the entire tumor and ensuring that patients are free from cancer – not only in that moment but also in the future. I once removed a 38-centimeter tumor while still preserving a large part of the kidney.
When it comes to kidney cancer, it’s sometimes simplified to a question of radical or partial. I think we should change that. Just because there are two kidneys doesn’t mean that one kidney is expendable – it’s not a spare. You can live with one eyeball too. Do you want to? It’s no different with the kidney.
Every nephron matters.
