Radical nephrectomy

Radical nephrectomy is 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?

First, 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. 1). Finally, the kidney is removed.

Fig. 1: The tumour is removed together with the whole kidney.
Fig. 1: The tumour is removed together with the whole kidney.

Radical nephrectomy can be performed with laparoscopic surgery. For this kind of surgery, the surgeon inserts small plastic tubes into your abdomen. Through these tubes the surgeon can insert the instruments needed to remove the kidney (Fig. 2). 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.

The laparoscopic procedure generally leads to faster recovery than open surgery. Nevertheless, the technique is demanding and your doctor needs be experienced in performing this type of surgery. Laparoscopic radical nephrectomy can also be done assisted by a surgical robot system.

Open radical nephrectomy may be recommended in certain medical cases or if laparoscopic surgery is not available in your hospital. For open radical nephrectomy, the surgeon cuts the abdominal wall to access the kidney directly. The procedure has a longer recovery time and there is higher risk of pain or complications after surgery compared to laparoscopy.

For the removal of a kidney tumour with radical nephrectomy, open and laparoscopic surgery are equally effective.

Fig. 2: For laparoscopic surgery the surgeon inserts the surgical instruments through small incisions in the abdomen.
Fig. 2: For laparoscopic surgery the surgeon inserts the surgical instruments through small incisions in the abdomen.

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. 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 localized kidney cancer. Around 90% of patients is still cancer free up to 5 years after surgery. 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. Routine follow-up lasts at least 5 years. Common tests during follow-up visits are abdominal CT scans, ultrasound, chest x-ray, and urine and blood analyses.