Helping Patients Understand the Evolving Landscape of Kidney Cancer Treatment

In the second part of our conversation with Dr. Ravi Munver, vice chair of Urology at John Theurer Cancer Center and chief of Minimally Invasive and Robotic Surgery at Hackensack University Medical Center, CURE explores the evolving landscape of kidney cancer treatment.

Munver shares insights on how minimally invasive techniques allow patients to preserve kidney function, the benefits of a multidisciplinary care approach, and practical guidance for navigating treatment and long-term follow-up.

CURE: What factors do you consider when deciding between partial versus radical nephrectomy for a patient?

Munver: The question of partial versus radical nephrectomy is a great one. When I started my fellowship about 25 years ago, we were taking out the overwhelming majority of kidneys, even for small tumors the size of a pea or a marble. Now, with the development of minimally invasive techniques like laparoscopic surgery and, most recently, robotic surgery, we are able to offer partial nephrectomy for the overwhelming majority of our patients. In fact, more than 80% of the kidney cancer surgeries that we do at Hackensack University Medical Center are partial nephrectomies, so we can save the kidneys in the overwhelming majority of patients.

The patients that need radical nephrectomies are patients that have very large kidney masses. Sometimes they have more than one kidney mass, or the kidney is not working very well with a potentially smaller tumor, in which case saving the kidney doesn't make any difference if the kidney is not functioning, or if patients have recurrence of tumors in that kidney that may not be amenable to cutting the tumor out and reconstructing the kidney.

Just yesterday, I had a very fascinating case of a gentleman who was 71 years old. He had a kidney biopsy because he had a big mass that was invading deep into his kidney, and he was told by two other institutions in the area that he needed his kidney removed. He came to me because the pathology results came back as kidney cancer, and we painstakingly did a very complex robotic partial nephrectomy yesterday, and were able to remove the tumor, save his kidney and he went home this morning.

How does multidisciplinary care at your center improve patient outcomes and support overall treatment planning?

The first two people I met when I came to Hackensack University Medical Center over two decades ago were a medical oncologist and a radiation oncologist. I'm a surgical oncologist, so I operate on patients to remove cancers, but in conjunction, we have a multidisciplinary approach toward kidney cancer with our medical oncologist and our radiation oncologist. In the instances that a kidney cancer is metastatic or advanced, these patients may still benefit from surgery, but they may also need targeted therapies, including immunotherapies. These types of therapies in conjunction with surgery can offer patients better results than either targeted therapies or immunotherapies or surgery alone.

Our multidisciplinary approach not only includes surgical oncologists like the urologist, medical oncologists who administer immunotherapies, targeted therapies, and chemotherapies, and radiation oncologists that administer radiation therapy, but we also work with our radiologists and our pathologists to look at imaging studies, to look at the pathology reports when we remove a tumor or perform a biopsy of a tumor. And we also work with our nephrologists, or medical kidney doctors, in patients that have pre-existing kidney disease or who may develop kidney disease down the road if they have other medical problems that may predispose them to potentially needing dialysis in the future.

For patients who are newly diagnosed with kidney cancer, what key advice would you give about navigating treatment options and more long-term care?

For patients that are recently diagnosed with kidney cancer, it is important for them to do a number of different things.

Number one, they need to understand the disease process. Kidney cancer is highly treatable and highly curable in the overwhelming majority of cases, when the cancers are detected early.

Number two, patients need to go to a center of excellence. Hackensack University Medical Center is one such center where we pride ourselves in offering not only the latest in imaging technologies, percutaneous biopsies, which means through the skin, to biopsy tumors, surgical therapies with robotics, immunotherapies, targeted therapies and radiation therapies. We are a premier center for kidney cancer, and it's important for patients with kidney cancer to go to centers of excellence so that they can receive the best treatment that is specialized for them.

Number three, they need to understand that even after receiving a therapy, whether it's surgery or whether it's radiation or whether it's some type of targeted therapy or immunotherapy, that it's going to be a long course. When I say a long course, I mean that even if patients are cured at year one or year two, they're going to continue their relationship with their surgeon or their medical oncologist or their radiation oncologist, such that they remain cancer-free for the rest of their life. So annual visits are important. The long haul in terms of follow-up is extraordinarily important so that patients can remain healthy and disease-free, absolutely.

Transcript has been edited for clarity and conciseness.

Reference

1. Understanding Recent Treatment Advancements in Kidney Cancer Care, by Ryan Scott. CURE; Sept. 22, 2025. https://www.curetoday.com/view/understanding-recent-treatment-advancements-in-kidney-cancer-care

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