Rethinking Kidney Cancer

Dr. Jaime Landman and his pioneering mentor brought minimally invasive surgical techniques to the field.

Growing up on Long Island, N.Y., Jaime Landman aspired to be a journalist—an international correspondent, exposing truth and injustice in South America and his family’s home country of Peru. But he wound up following a path much closer to home and made a distinctly different kind of impact on the world.

His father worked as a urologist, and while attending medical school at the Columbia University College of Physicians and Surgeons, Landman 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 has all these other interesting processes like regulating electrolytes and endocrine functions.”

Improving kidney cancer surgery

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

Starting in 1990, a surgeon at Washington University School of Medicine in St. Louis, Mo., named Dr. Ralph Clayman began pioneering laparoscopic renal surgeries. “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 whole new perspective. “I began to understand we were minimally invasive thinkers—that by thinking of creative ways to apply this technology, we might avoid surgery altogether.” Clayman left Washington University to become chair of the UC Irvine Health Department of Urology and, later, dean of the 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.”

By thinking of creative ways to apply this technology, we might avoid surgery altogether.

Discovering the benefits of a kidney biopsy

Together they 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 check 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.

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 tissue) and radiofrequency ablation (using electrical current produced by radio waves to heat tissue) as an alternative to the nephrectomies that 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,” he 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.”