Nephrectomy

Surgery is the main treatment for most kidney cancers. The surgical procedure, known as a nephrectomy, may involve removing all or just part of your kidney. Some patients may require removal of nearby tissues and lymph nodes as well.

The types of surgery used for kidney cancer are:

• Simple nephrectomy
• Radical nephrectomy
• Partial nephrectomy

Which type is right for you depends on where the tumor is located, how big it is, how many tumors you have, and whether the cancer has spread to nearby lymph nodes or distant organs.

Simple nephrectomy: This surgery is to remove all of one kidney.

Radical nephrectomy: As with a simple nephrectomy, this one involves removing an entire kidney. However, a radical nephrectomy also involves removal of the adrenal gland (which sits atop the kidney) and a section of the ureter (the tube that leads to the bladder). Fatty tissue surrounding the kidney also may be excised.

Your doctor is likely to recommend a radical nephrectomy if your tumor is large or is located in the middle of your kidney, or if you have multiple tumors in one kidney. Also, a radical nephrectomy may be recommended if the cancer has spread to your lymph nodes or other organs.

Some kidney tumors grow directly in the renal vein and enter the vena cava, the largest vein in the body, on its way to the heart. In this case, you need a cardiovascular surgeon to assist with the removal of your kidney.

Partial nephrectomy: During a partial nephrectomy, the surgeon removes only the diseased section of your kidney. This is the preferred treatment for those whose cancer is in the early stages.

If you have a single tumor that’s smaller than 4 cm, your surgeon is likely to recommend a partial nephrectomy. However, a partial nephrectomy may be performed on tumors as large as 7 cm.

An advantage to a partial nephrectomy is that you still have a working kidney. Also, the surgeon makes a smaller incision with a partial nephrectomy than with a radical nephrectomy, which likely means fewer side effects and a faster recovery.

Open, laparoscopic and robotic surgery

There are different approaches to kidney surgery as well.

• Open: This is the traditional approach and requires a long incision.
• Laparoscopic: This is a minimally invasive approach. The surgeon makes small cuts in your abdomen and inserts a video camera and the medical instruments necessary to remove your entire kidney or part of it.
• Robotic: This is also a minimally invasive approach. Working from a computer workstation near the operating table, your surgeon is able to control robotic arms and use them to make incisions and to remove your kidney or part of your kidney.

Laparoscopic and robotic surgery may take longer than traditional open surgery, but they may allow for a quicker recovery than open surgery. Your scars may fade with time.

Neither minimally invasive approach may be possible if your tumor measures more than 7 cm, or if it’s grown into the renal vein or spread to nearby lymph nodes.

Laparoscopic and robotic nephrectomies require special expertise. You should look for a surgeon who has this expertise if this is your appropriate option.

Related surgeries

In addition to removing your kidney or part of your kidney, your surgeon also may perform these surgeries at the same time.

• Regional lymphadenectomy: To tailor your treatment to your disease, your doctors want to know whether your nearby lymph nodes contain cancer. During your radical nephrectomy, your surgeon may remove nearby lymph nodes and send them to the pathology laboratory to look for cancer. Your surgeon also may perform this procedure if your tumor has features that indicate it may be at high risk of spreading. The lymph nodes may have appeared enlarged on pre-surgical imaging studies, or the surgeon thinks they look suspicious during surgery.
• Adrenalectomy: A radical nephrectomy likely includes removing your adrenal gland as well. However, if your tumor is located near the bottom of your kidney (away from your adrenal gland), your surgeon may opt to leave it alone.
• Removal of metastases: Kidney cancer commonly spreads to the lymph nodes, lungs, bones and liver. There’s about a 33 percent chance that kidney cancer has spread to other areas of the body by the time of diagnosis, according to the American Cancer Society. If this is the case for you, ask your care team whether this spread may be removed during your kidney surgery.

How to prepare for nephrectomy

• Follow instructions about when to stop eating and drinking beforehand.
• If you take medication, ask your doctor whether you should take it the day of your surgery. Don’t take aspirin or blood thinners, as these may lead to excessive bleeding.
• Shower or bathe before surgery. Don’t use skin lotions, perfumes, deodorant or nail polish.
• Don’t wear contact lenses, piercings or other jewelry.
• If your doctor orders it, you’ll need to empty your bowels with a laxative or enema.
• Arrange for someone to drive you to and from your surgery.
• Ask your care team any questions or concerns you may have about your surgery and what exactly your surgeon plans to do.
• If you have an advance care plan, make sure your health care team has a copy. If you don’t, you may want to prepare one.
• Don’t forget to bring along photo identification.

How surgery is performed

These types of kidney surgery are performed in the hospital, require general anesthesia and typically take about three or more hours.

During a simple nephrectomy, open kidney surgery and radical nephrectomy: Your surgeon cuts an incision—up to 12 inches—below your ribs or over your lowest rib. Your surgeon may have to remove a rib to move muscle, fat and tissue and reach your kidney. After the necessary removals, your incision is closed with stitches or staples.

Specifically, during a radical nephrectomy:

• A cut—about eight to 12 inches—is made on the front of your abdomen below your ribs or through your side.
• Your surgeon cuts and moves muscle, fat and tissue.
• Your ureter is removed.
• Your kidney is removed.
• Your surgeon also may remove surrounding fat, the adrenal gland at the top of your kidney and some lymph nodes.
• Stitches or staples are used to close your incision.

During laparoscopic nephrectomy:

• Your surgeon makes three to four small cuts, no more than 1 inch each, on your belly and side.
• A video camera and other instruments are inserted through the cuts to help guide the procedure.
• The surgeon will later make one larger cut (about 4 inches) to remove your kidney.
• The surgeon cuts the ureter and places a bag around the kidney to pull it out through the large incision.
• Your incisions are closed.

After surgery, movement is important to prevent deep vein thrombosis (blood clots), also known as DVT. If you’re at high risk for DVT, you may be given a preventive dose of blood thinners and asked to wear compression stockings.

You may be discharged from the hospital in one to seven days, depending on the type of surgery and how fast you recover.

Risks of nephrectomy

A nephrectomy is surgery, which means there may be some risks involved. Your doctor may be able to give you medication that provides pain relief or provide other treatments. Possible risks include:

• Reaction to anesthesia
• Excessive blood loss
• Blood clots
• Infections
• Pain
• Damage to nearby organs during surgery
• Pneumothorax (collapsed lung)
• Hernia at the incision site
• Urine leakage into the abdomen
• Kidney failure

What to expect after surgery

It may take three to six weeks to recover from kidney surgery. You should be able to resume normal activities in four to six weeks.

You may experience pain in your belly or on your side where your kidney was removed. You also may have:

• Bruising around incisions
• Redness around incisions

To speed your recovery and stay safe, consider these tips:

• Avoid lifting anything heavier than 10 pounds.
• Avoid activities that cause you to strain or breathe hard.
• Get moving. Take short walks. Use the stairs. Do light housework if you’re up to it.
• Apply ice to your wound, but keep it dry.
• When you sneeze or cough, press a pillow over your incision.
• Ask your doctor about any pain medication you may need. If you take pills, remember to take them on a set schedule, the same time each day. They may be more beneficial this way.
• Keep your incision clean, dry and protected. Don’t take baths or swim until your doctor says it’s OK.

In most cases, you may eat a normal healthy diet. Be sure to drink four to eight glasses of water or liquid a day. Ask your doctor whether you need special dietary instructions or restrictions.

Some pain medications may cause constipation. Moving may help, and so can foods that are high in fiber. Ask your doctor about laxatives or stool softeners if necessary.

Call your doctor if:

• Temperature rises above 100.5℉
• Wounds bleed, are warm to the touch, or have a yellow, milky or green discharge
• Belly swells
• You’re nauseous or vomiting for a day or more
• You have difficulty breathing or a lingering cough
• You can’t urinate

Any of these may be signs of an infection.

Post-surgery care

You have two kidneys and can live with one healthy kidney. Your doctor will order tests to be sure your healthy kidney remains so. These tests include:

• Urinalysis
• Creatinine
• Glomerular filtration rate (GFR)
• Other tests for protein in urine

If you have one kidney, you should avoid sports or any activities where you may be injured by a collision or heavy contact.

Results

The success of surgery depends largely on the cancer stage at diagnosis.

• If your tumor hasn’t spread beyond your kidneys, surgery may be the only treatment needed.
• If your cancer has spread, speak with your doctor about your options for treating this metastasis. If your cancer has spread to only one spot, you may need additional surgery to remove it.