The vast majority of renal tumors are malignant, or what we call renal carcinoma, the subtype of which is most common in clear cell carcinoma, which is more common in males than females, about two to four times more common in females, and more common in patients over 40 years of age. There are also a small number of benign malignant tumors. In recent years, patients with kidney tumor are gradually getting younger, and with the popularity of people’s medical checkups, they are found earlier and earlier. When the kidney tumor is found, how to choose the method of surgery? Today I will talk to you about the related knowledge. Are there any symptoms of kidney tumor? Many patients want to know whether there are any typical symptoms of kidney tumor, so that they can compare the symptoms and detect kidney tumor earlier. Kidney cancer has the classic triad of “hematuria, low back pain, abdominal mass”, but the appearance of these symptoms is less than 20% of the patients. 1. Hematuria occurs only when the tumor tissue erodes into the renal calyx and renal pelvis and other structures. Typically, it is painless hematuria, when this happens, we should highly suspect urinary tumor. 2.With the continuous expansion and growth of the tumor, the renal peritoneum is subjected to a certain tension, and then the patient will feel a kind of hidden distension and pain in the posterior lumbar region. 3.When the tumor is bigger, hard lumps can be felt in the waist. When the above situations occur, you should go to the hospital immediately for detailed examination to exclude the existence of kidney tumor. How to detect kidney tumor in time? For early detection of kidney tumor, it is simple and clear to do an abdominal ultrasound, usually for kidney tumor above 1cm, ultrasound can be found. Once occupying lesions are detected by ultrasound, it is especially important to do CT of kidney, which is more accurate than ultrasound to diagnose kidney cancer. Of course, CTA and GFR will follow. CTA can help the surgeon to clarify the blood supply of the kidney and tumor before operation, which is of great significance in guiding the intraoperative operation, and GFR can assess the renal function of the patient before operation, which is of great significance in guiding the preservation and retention of the affected kidney. As shown in Figure 1, it is a case of renal tumor that we operated on, the tumor diameter is 6cm, accounting for one half of the whole kidney volume, and the location is deeper, which makes the operation more difficult. What are the treatments for renal tumors? For most of the kidney tumor patients, the most confusing thing is that they have kidney cancer but they don’t know what kind of treatment to choose. As far as treatment is concerned, kidney tumor is not sensitive to radiotherapy and chemotherapy. At present, for advanced kidney cancer patients, especially when kidney cancer has metastasis (metastasis of kidney cancer usually occurs in lungs, bones, liver, brain and other organs), they have already lost the chance of surgery, and they can only use targeted therapy or biological therapy; for early and mid-stage kidney cancers, surgery is the most effective way to achieve the goal of radical treatment. However, many patients are at a loss of what to do in the face of surgical methods, whether to choose radical nephrectomy or partial nephrectomy for kidney cancer? (Radical nephrectomy for kidney cancer: the whole kidney is cut off, so as to achieve the goal of completely removing the tumor and curing kidney cancer. Partial nephrectomy is to remove the whole kidney tumor, that is, to remove a part of the kidney, commonly known as “kidney preservation surgery”). If you choose to remove the whole kidney, many patients are afraid that the tumor will grow on the opposite side of the kidney in the future, or they are worried that they only have one kidney left, which cannot maintain the daily metabolic function of the kidney; if you choose to have partial nephrectomy, you are worried that the tumor will not be cut cleanly, and the tumor will recur or metastasize in the future. What are the advantages of “kidney preservation surgery”? At present, the clinical indications for partial nephrectomy are exophytic renal tumors less than 4cm in diameter. 4-7cm renal tumors can also be treated with partial nephrectomy, which is much more difficult, and it is more suitable for tumors growing on the surface of the kidney with exophytic growth. Foreign statistics, the cure rate of renal tumors less than 7cm with partial nephrectomy has been comparable with radical nephrectomy for renal cancer, so we urologists have to spare no effort to keep the patient’s kidney. In terms of postoperative patient recovery, partial nephrectomy significantly preserves the patient’s kidney function. Only for doctors, “kidney surgery” is much more difficult than cutting off the kidney, need to carefully find each artery in the kidney during the operation, the arteries will be temporarily blocked, but also in less than 30 minutes, the tumor is removed, and then use the needle and thread layer by layer to sew up the kidney, if the sewing is too slow, more than 45 minutes, the function of the kidney will be greatly impaired, and the patient will not be able to recover. If the stitches are too slow, more than 45 minutes, the function of the kidney will be greatly damaged. “Kidney preservation surgery” is an iconic and difficult surgery for every urologist, which requires complete removal of the tumor, fast suturing as possible, and minimal bleeding, so that the patient will recover quickly after the surgery. The kidneys are like a sewage treatment plant for the human body, the “root” of the human body. Kidney unit is one of the workshops of this huge factory, and partial nephrectomy is to save the normal workshop as much as possible. Although theoretically one kidney can maintain the daily metabolism of the human body, the residual kidney after partial nephrectomy can’t be ignored to share the work of the opposite side of the kidneys, and to give the opposite side of the kidneys a chance to rest. Nowadays, there are more and more patients with chronic diseases such as high blood pressure and diabetes, and these diseases lead to the deterioration of renal function. As the saying goes, “if you have a green mountain, you are not afraid of having no firewood to burn”, so the significance of partial nephrectomy is particularly important. What are the characteristics of minimally invasive treatment of renal tumor? Nowadays, most of the partial nephrectomies can be done laparoscopically, which is less traumatic, with less intraoperative bleeding, faster recovery and shorter hospitalization time. From a 20cm incision to only a 3-5cm incision, there is no doubt that it is quite favorable to the patient’s recovery. During the operation, the operator will completely remove the tumor along the renal tumor envelope, and then carefully take out the tumor along the channel established by minimally invasive surgery without breaking the tumor envelope in the whole process. Absorbable thread will be used to sew up the kidney opening after removing the tumor. Generally, we are used to sewing three layers from the inside to the outside, and the post-operative kidney only looks a little bit smaller than the pre-operative kidney. Moreover, laparoscopy is now equipped with high-definition cameras, so that the surgical field of view can be enlarged, so that the surgical area has no dead angle; and now there is a 3D laparoscopy, which significantly improves the three-dimensional sense of the tiny surgical area, compared with the previous open surgery, so that the operator’s view of the surgical area is more comprehensive, and the surgical area of the operation is more delicate. Our department performs more than 150 laparoscopic renal tumor surgeries per year, and we are experienced in partial nephrectomy of complex renal tumors, radical treatment of giant renal tumors, and minimally invasive treatment of renal tumors, which are performed by a large number of patients. Many patients who can only have their kidneys removed because of large and deep tumors in local hospitals have been treated with “kidney preservation” in our department. What are the best ways to prevent kidney cancer? At present, the causes of kidney cancer are unknown, but the data of large sample clinical investigation show that: 1) Kidney cancer has high correlation with smoking, so we have to avoid smoking and reduce the exposure to second-hand smoke; 2) Environmental pollution is closely related to kidney cancer, such as frequent exposure to some toxic and harmful chemical pollutants. The incidence of kidney cancer in obese people is relatively high; 4, high blood pressure is also a predisposing factor of kidney cancer; 5, kidney cancer is also correlated with heredity, such as VHL syndrome and hereditary papillary renal cancer, etc. Therefore, patients with family history of kidney cancer should pay attention to regular medical checkups to achieve early prevention. Drinking more water also has certain preventive effect, keep the daily urine volume at 1500~2000ml, which can discharge our daily metabolic wastes as much as possible and reduce the accumulation of toxins in the kidneys; 7, you can eat more fresh fruits and vegetables on weekdays, and you can consume some fishes appropriately, especially the deep-sea fishes, and nowadays, some anti-cancer foods, such as mushrooms and garlic are considered to be of certain benefit to the body. Some anti-cancer foods, such as mushrooms and garlic, are also beneficial to the body. 8, usually to ban moldy food, eat less pickled, smoked, fried and barbecued food. 9. Of course, having a positive and healthy mindset and regular aerobic exercise are also important for the prevention of kidney cancer. Figure 9 and 10: Removal of 3 renal tumors using intraoperative ultrasound precise positioning