Radical nephrectomy is a surgical treatment option for locally-advanced kidney cancer. The aim is to remove the whole kidney that contains the tumour and the surrounding fatty tissue. In locally-advanced kidney cancers it may not be possible to remove the tumour and leave part of the kidney intact. Most people can live with only one functioning kidney without major complications.
You may need additional surgical procedures to remove the entire tumour. These include the removal of enlarged lymph nodes or the adrenal gland.
For a radical nephrectomy you will receive general anaesthesia. During the surgery, you will lay on your side or on your back, depending on the location and size of the tumour.
How is radical nephrectomy performed?
Radical nephrectomy can be performed by open or laparoscopic surgery.
Open radical nephrectomy is the standard of care for locally-advanced kidney cancer. First, the size of the tumour is determined and the doctor checks which surrounding tissue or organs have been affected by it. The urologist then cuts the abdominal wall to access the kidney directly. To prevent tumour spillage, the urologist keeps your kidney covered with a protective layer of fatty tissue. The urologist separates the renal artery, renal vein and ureter from the kidney (Fig. 1).
For laparoscopic radical nephrectomy, the urologist inserts small plastic tubes into your abdomen. Through these tubes the urologist can insert the instruments needed to remove the kidney (Fig. 2). The laparoscopic procedure generally leads to faster recovery than open surgery. Nevertheless, the technique is demanding and your doctor needs to be experienced in performing this type of surgery. Laparoscopic surgery can also be done assisted by a surgical robot system.
For the removal of a locally-advanced kidney tumour, open and laparoscopic surgery are equally effective.
If you have enlarged lymph nodes, the urologist may decide to remove them in a procedure called lymphadenectomy. In some cases, the CT scan has shown that lymph nodes are enlarged and the doctor will discuss possible treatment with you. In other cases, the urologist detects enlarged lymph nodes during surgery and may decide to remove them.
Removal of the adrenal gland
The adrenal gland is an organ located on top of each kidneys (Fig. 1). It produces stress and steroid hormones. If the tumour has spread to the adrenal gland, the gland needs to be removed together with the kidney. This procedure is known as adrenalectomy. A CT scan before surgery can confirm that the tumour has spread to the adrenal gland. In other cases, the urologist detects tumour cells in the adrenal gland during surgery and will remove it. The remaining healthy adrenal gland continues to produce all the hormones needed.
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 need to stay in the hospital several days. The length of hospital stay can vary in different countries. You may experience minor pain in the side of your body for some weeks after open radical nephrectomy.
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 prescribed medication with your doctor
You need to go to your doctor or go back to the hospital right away if you:
- Develop a fever
- Have heavy blood loss or pain
Read more about support after surgery.
What is the impact of the treatment?
Radical nephrectomy is a common procedure for locally-advanced kidney cancer. Because you are left with one functioning kidney, there is increased risk of chronic kidney disease. Reduced kidney function is also a risk factor for cardiovascular disease.
What will the follow up be like?
After radical 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 10 years or can be life-long. Common tests during follow-up visits are abdominal and chest CT scans, ultrasound, chest x-ray, and urine and blood analyses. These are done to determine and monitor:
- Complications related to the surgery
- The status of the other kidney
- Any recurrence or metastasis
It is important that recurrences or metastases are detected early, so that it is possible to remove them with surgery.
Surgery after recurrence
If a recurrence is detected during follow-up, you may need additional surgery. Before this surgery your doctor may recommend to shrink the tumour with antiangiogenic therapy. It is also possible that your doctor recommends this therapy or ablation therapy after surgery.