I. Giant kidney tumor, can I save my kidney? What kind of kidney tumor can be called giant kidney tumor? Usually, we call those with diameter greater than 7cm as giant kidney tumors. At present, kidney cancer accounts for about 2% to 3% of adult malignant tumors and 80% to 90% of adult kidney malignant tumors. The incidence rate varies from country to country or region to region worldwide, overall the incidence rate in developed countries is higher than that in developing countries, urban areas is higher than that in rural areas, there are more men than women, and the ratio of male to female patients is about 2:1. The incidence age can be seen in all age groups, and the high incidence age is 50-70 years old. According to the National Cancer Prevention and Treatment Research Office and the Health Statistics Information Center of the Ministry of Health, the incidence and death data of tumors in pilot cities and counties in China show that the incidence of kidney cancer in China is increasing year by year, and has become the 10th incidence of malignant tumors in men in China by 2008. Is there any chance for kidney preservation surgery if the patient is diagnosed with huge kidney tumor? At present, there are many new technologies like cryoablation and radiofrequency ablation emerging in the treatment of kidney tumor, but for giant kidney tumor, surgery is still the most effective treatment means. Generally, as long as the indications for surgery are met, surgery will be the first choice. Whether the patient can be operated or not, and whether the patient can be operated, need to do detailed evaluation before surgery, mainly including the following aspects: 1) General condition: firstly, judge the patient’s physical condition, give certain nutritional support before surgery, and adjust the physical condition well before surgery. 2)Functional assessment: liver and kidney function, coagulation function, etc. are evaluated in detail and the conditions are met for surgery. 3)Imaging assessment: Ultrasound and CT enhancement plus 3D reconstruction (CTA) of the urinary system are used to determine the location and size of the tumor as well as the presence or absence of sub-foci, vascular invasion and cancer embolism, which provide the basis for the formulation of the surgical plan. 4) Kidney volume assessment: the volume of huge tumors are relatively large, even can occupy 2/3 of the total kidney volume, so the functional status of the remaining kidney after surgery should be assessed through imaging examination first, and the kidney volume should be reserved in order to protect the kidney function from failure after surgery; 5) There is a certain debate on kidney preservation surgery for huge tumors, but for patients with double kidney tumors or sole kidney tumors, every effort needs to be made to preserve the kidney and try to avoid However, for patients with double kidney tumors or sole kidney tumors, every effort should be made to preserve the kidney to avoid the occurrence of uremia. What are the advantages of “kidney-conserving surgery”? At present, the best indication for partial nephrectomy is for exophytic kidney tumors less than 4 cm in diameter. 4-7 cm kidney tumors can also be treated by partial nephrectomy, but it is very difficult, and it is more suitable for tumors that grow on the surface of the kidney and are exophytic in growth. According to foreign statistics, the cure rate of kidney tumor less than 7cm using partial nephrectomy has been comparable to radical nephrectomy for kidney cancer, so we urologists should spare no efforts to keep the kidney of patients. In terms of postoperative patient recovery, partial nephrectomy significantly preserves the kidney function of patients. However, for doctors, “kidney preservation surgery” is much more difficult than cutting off the kidney, which requires careful finding of each artery of the kidney, temporary blocking of the artery, removal of the tumor within 30 minutes, and stitching up the kidney layer by layer, if the stitching is too slow and takes more than 45 minutes, the function of the kidney will be affected. If the stitching is too slow and takes more than 45 minutes, the function of the kidney will be greatly damaged. “Kidney surgery is a landmark 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 surgery. The kidneys are like a human sewage treatment plant, the “root” of the human body. Although theoretically one kidney can maintain the daily human metabolism, the residual kidney after partial excision cannot be ignored to share the work of the opposite kidney and give the opposite kidney a chance to rest. Nowadays, there are more and more patients with chronic diseases such as hypertension and diabetes, and these diseases are the diseases that lead to the deterioration of kidney function, as the saying goes, “if you keep the green hills, you are not afraid of no firewood”, so the significance of partial excision of kidney is particularly important. What kind of giant kidney tumor patients cannot be operated? 1) Patients with other cardiovascular and cerebrovascular diseases; extremely poor physical condition, unable to tolerate surgery; 2) Extra-renal metastasis of kidney tumor: that is, metastasis to organs other than kidney, the most common one is lung metastasis of kidney tumor, besides, bone metastasis, brain metastasis and extensive lymph node metastasis in abdominal cavity may also occur; II. Laparoscopic kidney preservation surgery, is it risky? Can laparoscopic resection be performed for large renal tumors? Nowadays, the vast majority of partial nephrectomies can be done laparoscopically with less trauma, less intraoperative bleeding, faster patient recovery and shorter hospital stay. From a 20 cm incision to only 3-5 cm incision, there is no doubt that it is quite beneficial to the patient’s recovery. During the surgery, the operator will remove the tumor completely along the kidney tumor envelope, and then carefully remove the tumor along the channel established by the minimally invasive surgery, without breaking the tumor envelope during the whole process. The tumor is then carefully removed along the channel established by the minimally invasive surgery, without breaking the tumor envelope during the whole procedure. The openings of the kidney after the removal of the tumor are sutured up with absorbable threads, and we are usually used to suture three layers (2+1) from the inside out. Moreover, laparoscopy is now equipped with high-definition camera, which enables the surgical field of view to be enlarged, so that there is no dead angle in the surgical area; and now there is 3D laparoscopy, which more significantly improves the three-dimensional sense of the tiny surgical area, making the operator’s observation of the surgical area more comprehensive and the operation of the surgical area more delicate compared with the previous open surgery. What kind of results can be achieved after surgery for giant kidney tumor? We have rich experience in partial nephrectomy of complex kidney tumor, radical treatment of giant kidney tumor and minimally invasive treatment of kidney tumor, and the largest one has even done laparoscopic kidney preservation surgery for 10 cm tumor, and there are many patients who come here in admiration. Many patients who have been treated in local hospitals for large and deep tumors and can only have their kidneys removed have received “kidney preservation” treatment in our department. Do I need to continue supplemental treatment after surgery for a large kidney tumor? Depending on the postoperative pathology, targeted therapy or immunotherapy is available. III. Patients with kidney tumor intend to have surgery, need to know this! How long does it take to recover after giant kidney tumor surgery? Generally, the stitches of the surgical incision are removed on the 7th~8th day after surgery. Elderly patients can wait until the 9th~10th day to remove the stitches, after which they can be discharged home. After discharge, patients should pay attention to rest, gradually resume activities and avoid strenuous exercise as much as possible; in terms of diet, eat less greasy and stimulating food; quit smoking and drinking; and regular review after surgery, patients should be reviewed every three months after kidney cancer surgery, every three months within two years, every six months from two to five years after surgery, and once a year after five years. For patients taking targeted drugs, monthly follow-up is required. What is the approximate cost of the whole treatment process? If patients do not have other diseases and recover quickly, it is about 30-40,000; if they have other diseases and recover slowly, the cost of treatment will increase, depending on the recovery of the disease.