Cirurgia para Câncer de Rim

A cirurgia é o principal tratamento para a maioria dos carcinomas de células renais. Mesmo pacientes cuja doença se disseminou para outros órgãos poderão se beneficiar do tratamento cirúrgico. Dependendo do estadiamento e da localização do tumor e de outros fatores, a cirurgia pode ser realizada para a retirada do tumor e de uma parte do tecido renal adjacente, ou de todo o rim. A glândula suprarrenal e o tecido adiposo ao redor do órgão também podem ser removidos.

Os tipos de cirurgia renal são:

  • Nefrectomia Radical. Na nefrectomia radical são removidos o rim, a glândula adrenal e o tecido adiposo ao redor do rim. A maioria das pessoas vive normalmente com apenas um rim. Neste procedimento a incisão pode ser feira em vários locais, sendo os locais mais frequentes a parte central do abdome, abaixo das costelas do mesmo lado do tumor ou mesmo nas costas, logo atrás do rim.
  • Nefrectomia Parcial. Na nefrectomia parcial é removida apenas a parte do rim contendo a doença. Assim como na nefrectomia radical e dependendo da localização do tumor podem ser feitas várias incisões. Atualmente, este tipo de cirurgia é a técnica preferida para pacientes com câncer renal em estágio inicial. Muitas vezes, é realizada para remover tumores únicos entre 4 e 7 cm de diâmetro. Alguns estudos demonstram que, a longo prazo, esse método apresenta resultados similares à retirada de todo o rim. As nefrectomias parciais geralmente não são realizadas para tumores muito grandes, para os casos de vários tumores no mesmo rim, ou se a doença se disseminou para os gânglios linfáticos ou outros órgãos.
  • Nefrectomia Laparoscópica e Nefrectomia Laparoscópica Assistida por Robótica. Nesta cirurgia são feitas várias incisões pequenas, por onde são inseridos instrumentos especiais para auxiliar durante o procedimento. Um desses instrumentos tem um laparoscópio com uma câmara de vídeo na extremidade, que permite a visualização do interior do abdome. No momento da remoção do órgão, uma dessas incisões é aumentada para facilitar a retirada do rim. Esta abordagem pode ser utilizada para tratar tumores renais, mas que não podem ser tratados com nefrectomia parcial. Uma abordagem mais recente é a cirurgia laparoscópica remota usando uma interface robótica. Para o cirurgião, o sistema robótico pode proporcionar mais precisão no movimento dos instrumentos do que na cirurgia laparoscópica padrão. Esta abordagem pode não ser uma opção para tumores maiores que 10 cm de diâmetro ou que aqueles que se desenvolveram na veia renal ou ainda se disseminaram para os linfonodos ao redor do rim.
  • Nefrectomia Laparoscópica Parcial e Nefrectomia Laparoscópica Parcial Assistida por Robótica. Atualmente muitos médicos realizam nefrectomias parciais laparoscopicamente ou usando um robô conforme descrito acima.
  • Linfadenectomia Regional. Nesta técnica são removidos os gânglios linfáticos próximos para verificar algum sinal de doença nos linfonodos, muitas vezes este procedimento é realizado durante a nefrectomia radical. Isto é importante para ter um prognóstico mais preciso da doença.
  • Remoção da Glândula Adrenal (Adrenalectomia). Se nos exames de imagem se constatar que a glândula adrenal não foi afetada, pode não ser necessária sua remoção. Neste caso, semelhante à retirada dos linfonodos, este procedimento é decidido de forma individual e deve ser discutido com o médico antes da cirurgia.


Remoção de Metástases

Aproximadamente 25% dos pacientes com carcinoma de células renais já tem metástases quando são diagnosticados. Os órgãos mais comuns a apresentar metástases são os pulmões, ossos, cérebro e fígado. Em alguns pacientes, a cirurgia ainda pode ser útil:

  • Cirurgia curativa. Em casos raros, nos quais existe apenas uma única metástase ou apenas poucos tumores que podem ser facilmente removidos sem causar efeitos colaterais. A metástase pode ser removida, quando é realizada a nefrectomia radical ou posteriormente se houver uma recidiva da doença.
  • Cirurgia paliativa. Quando outros tratamentos não são suficientes, a remoção cirúrgica das metástases pode, às vezes, aliviar a dor e outros sintomas que se apresentam com a doença.


Riscos da Cirurgia

Os riscos a curto prazo de qualquer tipo de cirurgia incluem reações à anestesia, sangramento, formação de coágulos sanguíneos e infecções. A maioria dos pacientes sentirão pelo menos um pouco de dor após a cirurgia, e, se necessário,  serão  administrados medicamentos contra a dor.

Outros possíveis riscos da cirurgia podem incluir:

  • Danos em órgãos internos e vasos sanguíneos durante a cirurgia.
  • Pneumotórax (presença de ar dentro da cavidade torácica).
  • Hérnia incisional.
  • Escoamento de urina pelo abdome (após nefrectomia parcial).
  • Insuficiência renal.

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