The Simple Guide to Kidney Cancer Surgery

by Jeanine Barone Health Writer

A kidney cancer diagnosis is not an easy pill to swallow. But perhaps even more shocking is to hear that you’ll likely need surgery, immediately. Surgery to remove some or all of the cancer is the standard first line of treatment, as long as the cancer has not spread to other parts of your body, says Lee Ponsky, M.D., professor at the Urology Institute, Case Western Reserve University School of Medicine in Cleveland, OH. Sounds a bit scary and life altering, but as Dr. Ponsky notes, “You will not feel differently,” and in some cases kidney surgery may cure the disease completely.

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Surgery Basics

A nephrectomy (that’s the umbrella term doctors use for kidney surgery) removes the entire kidney or just part of it. The surgery is done by a urologic surgeon who weighs many factors to determine what specific type of nephrectomy is needed, considering the results from imaging tests such as a CT or MRI. Whichever surgery type you get, the length of your recovery can last between three to six weeks, depending on many things, including your age and health status. Should the cancer return after surgery, your doctor will discuss if additional surgeries may be needed. Click through to learn about the types of surgery and why each is helpful in treating kidney cancer.

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Radical Nephrectomy

A radical nephrectomy removes the entire kidney. According to Joseph D. Shirk, M.D., assistant professor of urology at David Geffen School of Medicine at UCLA, “In most cases, radical nephrectomies are done for large, invasive tumors where there is not much normal kidney remaining.” The surgeon can remove the kidney through a long incision (open radical nephrectomy), or via minimally invasive surgery, where small incisions are made. Minimally invasive surgery is typically performed either robotically or via a standard laparoscopy that relies on a special video camera called a laparoscope and thin-gauge instruments to cut away the kidney. Most (but not all) radical nephrectomies are now done with minimally invasive surgery, says Dr. Ponsky.

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Radical Nephrectomy: What to Expect

  • Right after surgery: You may have a catheter draining urine from your bladder and possibly a small abdominal tube draining any excess fluids. Both are removed once you’re able to walk or before you’re discharged. Most patients resume normal eating the day after surgery.

  • Complications: While rare, you may develop a bulge in the abdominal wall or a hernia where tissue protrudes from the incision.

  • Follow-up: Once or twice a year you’ll need a blood test that measures serum creatinine to gauge your kidney function, says Dr. Ponsky.

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Partial Nephrectomy

A partial nephrectomy removes the tumor, leaving behind healthy kidney tissue so that the remaining organ can continue its normal function of removing waste from the blood. This is the preferred surgery for early-stage renal cancer. A partial nephrectomy can be done via an open approach or minimally invasive techniques as already discussed. According to Dr. Shirk, “Open partial nephrectomies are rare since the advent of robotic surgery and are now used mostly for patients with multiple tumors or tumors in locations hard to access with the surgical robot.”

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Partial Nephrectomy: What to Expect

  • Right after surgery: You could be discharged the same day or within one to two days if you had a minimally invasive approach, or within three to four days with an open incision.

  • Complications: A hernia and bleeding are risks, because the kidney has a very rich blood supply—though “blood loss may be less with a robotic approach,” says Dr. Shirk. Also, if a tumor is very deep, urine may leak (the kidney produces urine) requiring another procedure to drain it.

  • Follow-up:You can definitely be active (climbing stairs, walking short distances), but discuss any activity with your doctor to be sure.

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Regional Lymphadenectomy

This surgery (aka lymph node dissection), which could be done during a radical nephrectomy, involves removal of lymph nodes located near the cancerous kidney. Lymph nodes are small structures that are part of the lymphatic system, which carries a fluid containing disease-fighting immune cells. Before surgery, if an MRI or CT scan shows that the nodes are enlarged or if they feel or look abnormal during the operation—perhaps indicating that the cancer has spread—your surgeon may decide to remove them.

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Regional Lymphadenectomy: What to Expect

  • Right after surgery: You may have a catheter draining urine or a small abdominal tube to drain excess fluids—both are removed once you’re able to walk or before you’re discharged.

  • Complications: There’s a risk of bleeding as well as leakage of lymphatic fluid. Though rare, bleeding could be serious, requiring a blood transfusion. The lymphatic leak could resolve on its own in a few weeks to months or may require medication or an additional procedure.

  • Follow-up: Once or twice a year you’ll need a blood test that measures serum creatinine to gauge your kidney function, says Dr. Ponsky.

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Adrenalectomy

An adrenalectomy, which may be done during a radical nephrectomy, removes the adrenal gland that sits atop the cancerous kidney. The body has two adrenal glands, which are small, triangular-shaped organs that produce several essential hormones, including cortisol that’s involved with regulating the immune system, blood pressure, metabolism and the body’s response to stress. If the results of imaging tests (MRI or CT scan) shows that the cancer has spread from the kidney to the adrenal gland, your surgeon may decide to remove it.

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Adrenalectomy: What to Expect

  • Right after surgery: You may have a catheter draining urine or small abdominal tube draining excess fluids—both are removed once you’re able to walk or before you’re discharged.

  • Complications: There’s a risk of bleeding that, while rare, could require a transfusion. There’s also a risk (though uncommon) of damage to nearby organs, including the spleen and liver. Finally, there have been reports of adrenal insufficiency where not enough hormones are being produced, requiring supplemental cortisol (such as prednisone).

  • Follow-up: Once or twice a year you’ll need a blood test that measures serum creatinine to gauge your kidney function, says Dr. Ponsky.

Jeanine Barone
Meet Our Writer
Jeanine Barone

Jeanine Barone is a scientist and journalist with an eclectic background. She’s a nutritionist and exercise physiologist who regularly writes about travel, health, fitness, and food for numerous top-tier publications. Jeanine enjoys active travel, especially long-distance cycling and cross-country skiing.