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Changing how kidney cancer surgery is done

May 09, 2018 | UCI Health
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UCI Health urologist Dr. Jaime Landman.

Growing up on New York’s Long Island, Jaime Landman aspired to be a journalist — an international correspondent who would expose injustice in South America and especially in his family’s home country of Peru. He wound up following a path much closer to home and has made a distinctly different kind of impact on the world.

Landman’s father was a urologist, and while attending the Columbia University College of Physicians and Surgeons, the son became intrigued with the same field.

“Looking back I guess it doesn’t seem mysterious, his positive influence,” he says. “But even while studying different parts of the anatomy, I was always fascinated by the kidney. It seems like such a simple organ. It’s a filter, but it also performs all these other interesting processes like regulating electrolytes and endocrine functions.”

Improving kidney surgery

Landman’s fascination led him not only to become a urologist but also to specialize in kidney disease. But it was a new, minimally invasive approach to kidney surgery that inspired what he does today.

At Washington University School of Medicine in St. Louis, Mo., urologist Dr. Ralph V. Clayman became the first to perform laparoscopic renal surgeries through keyhole incisions in 1990. “I realized this could be really big for cancer,” Landman says. “So I flew out to St. Louis and got a job with him.”

Working with Clayman gave Landman a new perspective on treating kidney disease.

“I began to understand that we were minimally invasive thinkers — that by thinking of creative ways to apply this technology, we might avoid open surgery altogether.”

Clayman left Washington University to become chair of the UCI Department of Urology and, later, dean of the UCI School of Medicine.

“When he became dean, he interviewed me for a job,” Landman says. “He’s a mentor’s mentor, and ours is like a father-son relationship. Now he and I are partners developing minimally invasive techniques, and he continues to be a great mentor to me.”

Perfecting a kidney biopsy technique

Together Landman and Clayman continued to make revolutionary advances, applying their minimally invasive philosophy to the diagnosis and treatment of kidney cancer. They were bucking a longstanding tradition. For more than 100 years, patients suspected of having kidney cancer had one option: an open incision and removal of all or part of the organ, called total or partial nephrectomy.

The idea of doing a biopsy to determine whether a suspicious growth was cancerous or benign was unheard of.

“The first thing people would say is they had this horrible fear of seeding,” meaning that the biopsy might release cancer cells that would spread to other parts of the body, Landman explains.

“We finally beat that back with data. The reality is, only 11 people in the world have ever had seeding events from kidney cancer. The benefits of biopsy so outweigh the risks that they are routine for almost every other cancer.”

To help make biopsies for kidney tumors a reality, Landman and his team invented a device that guides a biopsy needle to take a quick and nearly painless sample without surgery. “With biopsies of small renal masses, we can eliminate the need for surgery in about 24 percent of patients,” he says.

Ablative treatment for kidney cancer

And for those patients who do have cancer, Landman helped create the nation’s first multidisciplinary ablative oncology center, along with a way to destroy tumors using cryotherapy (freezing) and radiofrequency ablation (using electrical current produced by radio waves to heat tissue) as an alternative to the nephrectomies, which have been the standard of care for more than a century.

“I’ve always been driven by the injustice of cancer. It takes people who were healthy and destroys their lives,” Landman says.

“With these new technologies, we can cure patients with small outpatient procedures. They get to go home the same day, eat dinner with their families and sleep in their own beds.”

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