This page was reviewed under our medical and editorial policy by

Bertram Yuh, MD, MISM, MSHCPM, Urologic Surgeon, City of Hope | Duarte

This page was updated on June 2, 2023.

Surgery is the main treatment for most kidney cancers. One such kidney cancer treatment is a nephrectomy.

What is a nephrectomy?

During a nephrectomy, the surgeon removes part or all of the patient's kidney. If both kidneys are removed, it's referred to as a bilateral nephrectomy.

Some patients may require removal of nearby tissues and lymph nodes in addition to the kidney.

Types of kidney removal surgery

The types of nephrectomy for kidney cancer are:

  • Radical nephrectomy
  • Partial nephrectomy

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

Radical nephrectomy

This surgery involves removing an entire kidney, a section of the ureter (the tube that leads to the bladder) and potentially the adrenal gland (which sits atop the kidney). Fatty tissue surrounding the kidney also may be excised.

The care team is likely to recommend a radical nephrectomy if the kidney tumor is large or is located in the middle of the kidney, or if multiple tumors are present in one kidney. Also, a radical nephrectomy may be recommended if the cancer has spread to the 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, a cardiovascular surgeon will assist with the kidney removal surgery.

Partial nephrectomy

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

If the patient has a single tumor that’s smaller than 4 cm, the 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 the patient still has a working kidney. Also, the surgeon makes a smaller incision with a partial nephrectomy than with a radical nephrectomy, which likely means fewer surgery side effects and a faster recovery.

Open, robotic and laparoscopic nephrectomy

Several other kidney surgery approaches are also available, as listed below.

Open nephrectomy: This is the traditional approach and requires a long incision.

Laparoscopic nephrectomy: This is a minimally invasive approach. The surgeon makes small cuts in the patient's abdomen and inserts a video camera and the medical instruments necessary to remove the entire kidney or part of it.

Robotic nephrectomy: This is also a minimally invasive approach. Working from a computer workstation near the operating table, the surgeon is able to control robotic arms and use them to make incisions and to remove the entire kidney or part of it.

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

Neither minimally invasive approach may be possible if the 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. The patient should look for a surgeon who has this expertise if this is his or her preferred option.

How to prepare for nephrectomy

  • Follow instructions about when to stop eating and drinking beforehand.
  • Ask the care team whether to take medication the day of 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.
  • The care team may require the patient to empty his or her bowels with a laxative or enema.
  • Arrange for someone to drive to and from the surgery.
  • Ask the care team any questions or concerns about the surgery and what exactly the surgeon plans to do.
  • If the patient has an advance care plan, make sure the health care team has a copy. If not, it may be a good idea to prepare one.
  • Don’t forget to bring along photo identification.

How nephrectomy surgery is performed

These types of kidney surgery are performed in the hospital, require general anesthesia and typically take about three or more hours. The surgical process will depend on the surgical technique, and may differ depending on whether an open, robotic or laparoscopic procedure is performed.

During open kidney surgery and radical nephrectomy:

The surgeon cuts an incision—up to 12 inches—below the ribs or over the lowest rib. The surgeon may have to remove a rib to move muscle, fat and tissue and reach the kidney. After the necessary removals, the 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 the abdomen below the patient's ribs or through his or her side.
  • The surgeon cuts and moves muscle, fat and tissue.
  • The patient's ureter is removed.
  • The patient's kidney is removed.
  • The surgeon also may remove surrounding fat, the adrenal gland at the top of ther kidney and some lymph nodes.
  • Stitches or staples are used to close the incision.

During laparoscopic nephrectomy:

  • The surgeon makes three to four small cuts, no more than 1 inch each, on the patient's 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 the kidney.
  • The surgeon cuts the ureter and places a bag around the kidney to pull it out through the large incision.
  • The incisions are closed.

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

The patient may be discharged from the hospital in one to seven days, depending on the type of surgery and how fast he or she recovers.

Risks of nephrectomy

A nephrectomy is surgery, which means there may be some risks involved. The care team may be able to prescribe 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

Nephrectomy recovery

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

The patient may experience pain in his or her belly or on the side where the kidney was removed. The patient also may have:

  • Bruising around incisions
  • Redness around incisions

To speed recovery and stay safe, consider these tips:

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

In most cases, the patient may eat a normal healthy diet. Be sure to drink four to eight glasses of water or liquid a day. Ask the care team whether special dietary instructions or restrictions are necessary.

Some pain medications may cause constipation. Moving may help, along with foods that are high in fiber. Ask the care team about laxatives or stool softeners if necessary.

Call the doctor if:

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

Any of these may be signs of an infection.

Can people live with one kidney?

People have two kidneys and can live with one healthy kidney. The care team will order tests to be sure the patient's healthy kidney remains so. These tests include:

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

Life after kidney removal

If the patient has one kidney, he or she should avoid sports or any activities where he or she may be injured by a collision or heavy contact.

Outcomes after nephrectomy

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

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

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