Urologic Oncology · University Urology, PC · Knoxville, Tennessee
Kidney Cancer Treatment & Surgery
Comprehensive, subspecialty kidney cancer care — from early-stage surveillance to complex surgical resection and multidisciplinary management of advanced disease. One of the nation’s highest-volume centers for nephron-sparing surgery.
Our Approach
Individualized Kidney Cancer Care
Kidney cancer treatment is not one-size-fits-all. The right approach depends on tumor size, location, stage, and each patient’s overall health and goals. University Urology offers the full spectrum of kidney cancer treatment options — from active surveillance for small, low-risk lesions to complex, multi-team surgical procedures for advanced disease involving the vena cava or adjacent structures.
Our urologic oncologists perform among the highest volumes of kidney cancer surgery in the country and collaborate closely with medical oncology, vascular surgery, cardiothoracic surgery, and interventional radiology to ensure every patient receives the most appropriate, coordinated care.
One of the nation’s highest-volume centers for partial nephrectomy
Partial nephrectomy — surgically removing only the tumor while preserving the healthy kidney — requires advanced robotic technique and high surgical volume to perform safely and effectively. Our team performs partial nephrectomy at volumes that place University Urology among the leading programs nationally, including complex cases that many centers refer elsewhere.
Treatment Options
Kidney Cancer Treatment Modalities
Our team offers every evidence-based treatment approach for kidney cancer. The appropriate option is determined based on tumor characteristics, imaging findings, patient health, and goals of care.
Robotic Partial Nephrectomy
Robotic-assisted removal of the kidney tumor while preserving the surrounding healthy kidney tissue. The preferred approach for most localized kidney tumors — it protects long-term kidney function while achieving oncologically sound margins. Our program is among the highest-volume partial nephrectomy centers in the country, including tumors in complex anatomical locations.
Laparoscopic Radical Nephrectomy
Minimally invasive removal of the entire kidney, performed when partial nephrectomy is not feasible due to tumor size, location, or involvement of multiple kidney structures. Laparoscopic approach means smaller incisions, faster recovery, and less blood loss compared to open surgery.
Vena Cava Thrombectomy
In some kidney cancers, tumor thrombus extends into the renal vein and inferior vena cava — sometimes reaching the right atrium (level 4). Surgical removal of this thrombus alongside the kidney requires advanced open surgical technique and, in complex cases, coordination with vascular and cardiothoracic surgery. University Urology is the region’s only high-volume center for this complex operation.
Active Surveillance
Many small kidney masses (<3 cm) grow slowly and carry a low risk of metastasis. Active surveillance — structured periodic imaging without immediate intervention — is a guideline-supported option for select patients, particularly those who are elderly, have competing health risks, or have small, indolent-appearing tumors. We tailor surveillance protocols to each patient’s specific tumor characteristics and health status.
Cryotherapy & Ablative Approaches
Image-guided tumor ablation — including cryoablation and radiofrequency ablation — destroys the tumor using extreme cold or heat delivered through a needle under CT or ultrasound guidance. Performed by our interventional radiology colleagues, ablation is an effective option for patients who are not ideal surgical candidates or who have small, favorably located tumors.
Advanced Imaging & Staging
Accurate staging is essential for treatment planning. We utilize CT urogram, MRI with and without contrast, and when indicated advanced nuclear imaging to characterize tumors, evaluate venous involvement, assess lymph nodes, and identify distant metastases. Imaging is also used to monitor response to therapy and guide surveillance in patients managed non-operatively.
Advanced Disease
Kidney Cancer with Vena Cava Involvement
Renal cell carcinoma has a unique tendency to extend tumor thrombus directly into the renal vein and inferior vena cava (IVC). The extent of this thrombus — classified as levels 1 through 4 — determines the complexity of the operation and the subspecialty teams required.
Level 1
Thrombus limited to the renal vein. Managed by urologic oncology alone.
Level 2
Thrombus extends into the infradiaphragmatic IVC. Urologic oncology with possible vascular surgery support.
Level 3
Thrombus extends above the diaphragm into the supradiaphragmatic IVC. Requires vascular surgery collaboration.
Level 4
Thrombus extends into the right atrium. Requires cardiopulmonary bypass — cardiothoracic surgery essential.
The region’s only high-volume vena cava thrombectomy program
Most centers in East Tennessee and the surrounding region refer IVC thrombus cases elsewhere. University Urology, under Dr. Bienvenu, manages the full spectrum of vena cava involvement in-house at UTMC — coordinating with vascular surgery and cardiothoracic surgery for the most complex level 3 and 4 cases. Patients referred from outside institutions for this operation are seen promptly.
Multidisciplinary Care
A Full Team for Complex Kidney Cancer
Advanced and complex kidney cancer rarely requires only one specialty. University Urology coordinates care across subspecialties at UTMC to ensure patients with complicated disease have access to every resource they need under one roof.
Urologic Oncology
Surgical management, staging, surveillance, and coordination of the overall treatment plan.
Medical Oncology
Systemic therapy for metastatic or locally advanced disease — including immunotherapy, targeted therapy, and clinical trials.
Interventional Radiology
Image-guided ablation (cryotherapy, RFA), pre-operative embolization, and advanced diagnostic imaging interpretation.
Vascular Surgery
IVC reconstruction and level 2–3 thrombus management in collaboration with urologic oncology.
Cardiothoracic Surgery
Cardiopulmonary bypass and level 4 thrombus extraction for tumor extending into the right atrium.
Radiation Oncology
Stereotactic body radiation therapy (SBRT) for oligometastatic disease, palliative radiation when indicated, and primary treatment of small renal masses in patients who are not candidates for surgery or ablation (NCCN Category 2B).
Treatment by Stage
What to Expect Based on Stage & Tumor Characteristics
Treatment recommendations are individualized, but the following provides a general framework for how kidney tumors are approached at University Urology.
Small Renal Mass (<3 cm, T1a)
Active surveillance, robotic partial nephrectomy, ablation (cryotherapy/RFA), or SBRT for patients who are not candidates for surgery or ablation (NCCN Category 2B). Decision based on tumor growth rate, imaging characteristics, patient age, and comorbidities. Partial nephrectomy preferred for younger, healthy patients.
Localized Kidney Cancer (T1b–T2, 3–7+ cm)
Robotic partial nephrectomy where technically feasible. Laparoscopic radical nephrectomy when the tumor size or location makes partial nephrectomy unsafe. No active surveillance for tumors in this size range.
Locally Advanced with Vein Involvement (T3)
Radical nephrectomy with vena cava thrombectomy. Complexity and team composition depend on thrombus level. University Urology manages all thrombus levels including level 4 with cardiothoracic surgery at UTMC.
Metastatic or Advanced Disease (T4, M1)
Cytoreductive nephrectomy in select patients, systemic therapy (immunotherapy and/or targeted therapy) coordinated with medical oncology, and consideration of metastasectomy for oligometastatic disease. Managed through our multidisciplinary team.
Our Surgeons
Kidney Cancer Surgeons at University Urology
All five of our kidney cancer surgeons are fellowship-trained urologic oncologists or endourologists with advanced robotic and laparoscopic surgical training.
Dr. James M. Bienvenu
Urologic Oncology & Robotic Surgery
Partial nephrectomy, radical nephrectomy, vena cava thrombectomy (all levels). Fellowship: Urologic Oncology.
Dr. Wesley M. White
Urologic Oncology & Robotic Surgery
Partial and radical nephrectomy, robotic technique. Fellowship: Urologic Oncology. Department Chair.
Dr. Jonathan W. Angelle
Robotic Surgery & General Urology
Partial and radical nephrectomy, robotic-assisted and laparoscopic kidney surgery.
Dr. Ryan B. Pickens
Endourology & Advanced BPH
Partial and radical nephrectomy, minimally invasive kidney surgery. Fellowship: Endourology, Vanderbilt.
Dr. Eric C. Riedinger
Endourology & Stone Disease
Partial and radical nephrectomy, minimally invasive approach. Fellowship: Endourology, Ohio State.
Referred for a Kidney Mass or Kidney Cancer?
Our team will match you with the right surgeon and build a personalized treatment plan. Most patients are seen within days of referral.
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Preparation Instructions
Preparing for Your Surgery
If you have a kidney surgery scheduled at UTMC, review your preparation instructions below.
Need directions to UTMC for your surgery or PAT appointment? See Getting to UTMC.