Nephrectomy

Nephrectomy

Nephrectomy is the removal of a kidney. Nephrectomy can be cytoreductive, partial, or radical, depending on your situation.

Cytoreductive nephrectomy

Cytoreductive nephrectomy is recommended for kidney cancer patients whose cancer has spread to other tissue (metastatic). The goal of cytoreductive surgery is to remove as many cancer cells as possible. To do this, it may be necessary to remove surrounding organs as well. The spleen or the pancreas or parts of the intestines or the liver might be affected.

How is cytoreductive nephrectomy performed?

To undergo cytoreductive nephrectomy, you must be fit for surgery and have a tumour that can be removed. You will be asleep (general anaesthesia) during the operation. You will lie on your side or on your back, depending on the location and the size of the tumour. Cytoreductive nephrectomy is usually ‘open’, meaning that the surgeon will operate through an open cut (incision) in the body.

To begin, the tumour will be measured, and the doctor will see whether surrounding tissue or organs have been affected. Then the surgeon will cut the abdominal wall to access the kidney directly. To prevent the tumour from spilling cancer cells, the surgeon keeps the kidney covered with a protective layer of fatty tissue. The surgeon separates the tubes that connect to the kidney in order to remove it.

Cytoreductive partial nephrectomy

If the largest (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 procedure is rarely done. The aim is to remove the part of the kidney with the tumour but to leave as much as possible of the healthy kidney tissue intact. This procedure can be done as open surgery or by making small cuts and inserting tube-like instruments that allow the surgeon to see inside the body (laparoscopy).

What are the side effects of the procedure?

After cytoreductive nephrectomy, you may have minor pain in the side of your body for several weeks.

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. After cytoreductive nephrectomy for kidney cancer, your doctor will generally recommend drug treatment.

Partial nephrectomy

Partial nephrectomy is used to treat kidney cancer that has not spread to other tissue. It is recommended whenever possible. The aim is to remove the part of the kidney with abnormally growing cells (tumour) but to leave as much as possible of the healthy kidney.

How is partial nephrectomy performed?

You will be asleep (general anaesthesia) for partial nephrectomy. You will lie on your side or back during surgery, depending on the location and size of the tumour.

To begin, the exact location of the tumour is determined. Blood flow to the kidney could be temporarily stopped during the surgery to reduce blood loss and to have a better surgical view. This allows for the removal of the entire tumour. Crushed ice is sometimes used to lower the temperature of the kidney during the surgery to prevent damage from lack of blood flow.

After the tumour is removed, the surgeon will sew the wound closed and may apply medicine 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 double-J stent to make sure urine can flow through the urinary system (Fig. 2). The stent will be removed when your wounds have healed and urine flow is back to normal. This can take from several days to weeks.

Surgical approach

Partial nephrectomy can be performed two ways. The operation can be done through a cut in the abdominal wall to reach the kidney and the tumour directly (open surgery). It can also be done with tube-like instruments placed through small cuts to see inside the body (laparoscopic surgery) (Fig. 3). Laparoscopic surgery can also be done assisted by a surgical robot system.

Both techniques are equally effective. Laparoscopic surgery generally leads to faster recovery than open surgery, but the technique is demanding and your doctor needs to have experience doing this type of surgery.

Fig. 1: In partial nephrectomy the tumour is removed, leaving as much as possible of the healthy kidney tissue.
Fig. 1: In partial nephrectomy the tumour is removed, leaving as much as possible of the healthy kidney tissue.
A JJ-stent is inserted to make sure urine can flow through the urinary tract.
A JJ-stent is inserted to make sure urine can flow through the urinary tract.
Fig. 3: For laparoscopic surgery the surgeon inserts the surgical instruments through small incisions in the abdomen.
Fig. 3: For laparoscopic surgery the surgeon inserts the surgical instruments through small incisions in the abdomen.

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.

You need to go to your doctor or to the hospital right away if you:

  • Develop a fever
  • Have blood in the urine
  • Have heavy blood loss or pain

What is the impact of the treatment?

Partial nephrectomy is a common procedure for kidney cancer that has not spread. Most 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 analysis of the removed tumour. Follow-up visits continue for at least 5 years. Common tests at follow-up visits are imaging of the abdomen (CT and ultrasound scans), chest x-ray, and urine and blood analyses.

Radical nephrectomy

Radical nephrectomy is the removal of the whole kidney and the surrounding fatty tissue. It is done when it is not possible to leave a functioning kidney behind after a partial nephrectomy. It is generally recommended for kidney cancers that have not yet spread but that have grown into surrounding tissue. It is also used for stage I tumours when partial nephrectomy is not an option. Most people can live with only one functioning kidney without major complications.

How is radical nephrectomy performed?

You will be asleep (general anaesthesia) for radical nephrectomy. To begin, the size of the tumour is determined. To prevent tumour spillage, the surgeon keeps your kidney covered with a protective layer of fatty tissue. The surgeon then separates the renal artery, renal vein, and ureter from the kidney (Fig. 4). Finally, the kidney is removed.

Fig. 4: The tumour is removed together with the whole kidney.
Fig. 4: The tumour is removed together with the whole kidney.

Surgical approach

Radical nephrectomy can be performed two ways, and both are equally effective. The operation can be done through a cut in the abdominal wall to reach the kidney and the tumour directly (open surgery). It can also be done with tube-like instruments placed through small cuts to see inside the body (laparoscopic surgery) (Fig. 9). Laparoscopic surgery can also be done assisted by a surgical robot system.

Laparoscopic surgery generally leads to faster recovery than open surgery, but the technique is demanding and your doctor needs to have experience doing this type of surgery. Open radical nephrectomy may be recommended in certain medical cases or if laparoscopic surgery is not available in your hospital. The open approach has a longer recovery time, and there is higher risk of pain and complications after surgery compared with laparoscopy.

What are the side effects of the procedure?

Usually, you can leave the hospital between 3 and 7 days after surgery. 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.

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

What is the impact of the treatment?

Radical nephrectomy is a common procedure for kidney cancer that has not spread to other tissue. Most patients are cancer-free up to 5 years after surgery. Because you are left with only one functioning kidney, you have a higher risk of chronic kidney disease than if you had both. 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 analysis of the removed tumour. Follow-up visits will continue for at least 5 years. Common tests during follow-up visits are imaging of the abdomen (CT scans and ultrasound), chest x-ray, and urine and blood analyses.