Cytoreductive nephrectomy is recommended for metastatic kidney cancer if you are fit for surgery and if the tumour can be removed. The aim is to remove as much of the tumour as possible. In order to do this, it may be necessary to remove surrounding organs such as the spleen or the pancreas, or parts of the intestines or the liver.
For cytoreductive nephrectomy you will receive general anaesthesia. During the surgery, you will lay on your side or on your back, depending on the location and the size of the tumour.
How is cytoreductive nephrectomy performed?
The standard of care is open cytoreductive nephrectomy. First, the size of the tumour is determined and the doctor checks which surrounding tissue or organs have been affected by it. The surgeon then cuts the abdominal wall to access the kidney directly. To prevent tumour spillage, the surgeon keeps your kidney covered with a protective layer of fatty tissue. The surgeon finally separates the renal artery, renal vein and ureter from the kidney to remove the kidney.
Cytoreductive partial nephrectomy
If the primary tumour in the kidney is not very large, or if your other kidney is not working well, your doctor may recommend cytoreductive partial nephrectomy. This is a rare procedure. 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 intact. The procedure can be done through open surgery or laparoscopy.
Another possibility is to treat the tumour with ablation therapy. Ablation therapy can be either radiofrequency ablation (RFA) or cryotherapy. The aim of these procedures is to kill tumour cells by heating (RFA) or freezing (cryotherapy). It can be done under local or general anaesthesia.
Your doctor may recommend additional surgery to remove the metastatic tumours. This is only advised if it is technically possible to remove the metastases and if you are fit to undergo major surgery. This procedure can help if you are in a lot of pain or have other symptoms which cause discomfort.
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 prescribed 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?
After cytoreductive nephrectomy you may experience minor pain in the side of your body for some weeks.
Recommendations for 4-6 weeks after the surgery:
- Depending on your doctor’s advice, 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 any blood loss
- Experience acute pain
- Have blood in the urine
What is the impact of the treatment?
If cytoreductive nephrectomy is successful, it gives you the chance to live longer and you will have fewer side effects.
What will the follow-up be like?
After cytoreductive nephrectomy for kidney cancer, your doctor will generally recommend drug treatment.