Partial nephrectomy is a surgical treatment option for localized kidney cancer. It is recommended whenever possible. The aim is to remove the part of the kidney that has been affected by the tumour, and leave as much as possible of the healthy kidney tissue.
For a partial nephrectomy you will receive general anaesthesia. During surgery you will lay on your side or on your back, depending on the location and the size of the tumour.
How is partial nephrectomy performed?
First, the exact location of the tumour is determined. A renal artery clamp is used to stop the blood supply to the kidney during the surgery to minimise blood loss. This allows for the removal of the entire tumour. Crushed ice is sometimes used to lower the temperature of the kidney during the surgery and prevent damage from lack of blood flow.
After the tumour is removed the surgeon will suture the wound and apply sealing agents to stop further bleeding if necessary (Fig. 1).
If the tumour has invaded the collecting system of the kidney, the surgeon may need to place a JJ-stent to make sure urine can flow through the urinary system. The stent will be removed when your wounds have healed and your urine flow is back to normal. This can take anywhere between several days and a few weeks (Fig. 2).
Partial nephrectomy can be performed as open or laparoscopic surgery.
Open surgery is the standard of care for partial nephrectomy. The surgeon cuts the abdominal wall to access the kidney and the tumour directly.
Laparoscopic partial nephrectomy is a minimally invasive surgery. For this kind of procedure, the doctor inserts small plastic tubes into your abdomen. Through these tubes the surgeon can insert the instruments needed to remove the tumour. One of the small tubes is used to insert a camera which allows the surgeon to see a high-quality image of your kidney on a video monitor (Fig. 3). Laparoscopic surgery can also be done assisted by a surgical robot system.
Laparoscopic surgery generally leads to faster recovery compared to open surgery, but the technique is demanding and your doctor needs to be experienced in this type of procedure.
For the removal of a kidney tumour with partial nephrectomy, open and laparoscopic surgery are equally effective.
How do I prepare for the procedure?
Your doctor will advise you in detail about how to prepare for the procedure. You must not eat, drink, or smoke for 6 hours before surgery to prepare for the anaesthesia. If you are taking any medication discuss it with your doctor. You may need to stop taking it several days before surgery.
What are the side effects of the procedure?
Usually you can leave the hospital between 3 and 7 days after surgery. Keep in mind that the length of hospital stay can vary in different countries. After open partial nephrectomy, you may experience some pain on the side of your body for several weeks.
Recommendations for 4-6 weeks after the surgery:
- Drink 1-2 litres every day, especially water
- Do not lift anything heavier than 5 kilograms
- Do not do any heavy exercise
- Discuss any medication you are taking
- If necessary, discuss the date to remove the JJ-stent with your doctor
You need to go to your doctor or back to the hospital right away if you:
- Develop a fever
- Have blood in the urine
- Have heavy blood loss or pain
Read more about support after surgery.
What is the impact of the treatment?
Partial nephrectomy is a common procedure for localized kidney cancer. More than 95% of patients remain cancer free up to 5 years after this surgery. The benefit of having two functioning kidneys after surgery contributes to overall kidney function and general health.
What will the follow-up be like?
After partial nephrectomy for kidney cancer, your doctor will plan regular follow-up visits with you. How often these visits are needed depends on the classification of the removed tumour. Follow-up lasts at least 5 years. Common tests during follow-up visits are abdominal CT and ultrasound scans, chest x-ray, and urine and blood analyses.