Even people whose cancer has spread to other organs may benefit from surgery to take out the kidney tumor. Removing the kidney containing cancer can help some people live longer, so a doctor may suggest surgery even if cancer has spread beyond the kidney. Kidney removal can also be used to ease symptoms such as pain and bleeding.
Depending on the stage and location of cancer and other factors, surgery might be done to remove either cancer along with some of the surrounding kidney tissue (known as a partial nephrectomy), or the entire kidney (known as a radical nephrectomy). The adrenal gland (the small gland that sits on top of each kidney) and fatty tissue around the kidney is sometimes removed as well.
In this operation, the surgeon removes your whole kidney, the attached adrenal gland, nearby lymph nodes, and the fatty tissue around the kidney. Most people do just fine with only one working kidney.
The surgeon can make the incision in several places. The most common sites are the middle of the abdomen (belly), under the ribs on the same side as cancer, or in the back, just behind the kidney. Each approach has its advantages in treating cancers of different sizes and in different parts of the kidney. Although removing the adrenal gland is a part of a standard radical nephrectomy, the surgeon may be able to leave it behind in some cases where the cancer is in the lower part of the kidney and is far away from the adrenal gland.
If the tumor has grown from the kidney through the renal vein (the vein leading away from the kidney) and into the inferior vena cava (the large vein that empties into the heart), the heart may need to be stopped for a short time in order to remove the tumor. The patient is put on cardiopulmonary bypass (a heart-lung machine) that circulates the blood while bypassing the heart. If you need this, a heart surgeon will work with your urologist during your operation.
Laparoscopic nephrectomy and robotic-assisted laparoscopic nephrectomy: These newer approaches to the operation are done through several small incisions instead of one large one. If a radical nephrectomy is needed, many doctors and patients now prefer these approaches when they can be used.
For a laparoscopic nephrectomy, special long instruments are inserted through the incisions, each of which is about 1/2-inch (1.27cm) long, to remove the kidney. One of the instruments, the laparoscope, is a long tube with a small video camera on the end. This lets the surgeon see inside the abdomen. Usually, one of the incisions has to be made longer in order to remove the kidney (although it’s not as long as the incision for a standard nephrectomy).
A newer approach is to do the laparoscopic surgery remotely using a robotic system. The surgeon sits at a panel near the operating table and controls robotic arms to perform the operation. For the surgeon, the robotic system may provide more maneuverability and more precision when moving the instruments than standard laparoscopic surgery. But the most important factor in the success of either type of laparoscopic surgery is the surgeon’s experience and skill. This is a difficult approach to learn. If you are considering this type of operation, be sure to find a surgeon with a lot of experience.
The laparoscopic approach can be used to treat most renal tumors that cannot be treated with nephron-sparing surgery (see below). In experienced hands, the technique is as effective as a standard (open) radical nephrectomy and usually results in a shorter hospital stay, a faster recovery, and less pain after surgery. This approach may not be an option for tumors larger than about 10 cm (4 inches) across or tumors that have grown into the renal vein or spread to lymph nodes around the kidney.
In this procedure, the surgeon removes only the part of the kidney that contains cancer, leaving the rest of the kidney behind. As with a radical nephrectomy, the surgeon can make the incision in several places, depending on factors like the location of the tumor.
Partial nephrectomy is now the preferred treatment for many people with early-stage kidney cancer. It is often done to remove single small tumors (less than 4 cm across), and can also be done to remove larger tumors (up to 7 cm across). Studies have shown the long-term results to be about the same as when the whole kidney is removed. The obvious benefit is that the patient keeps more of their kidney function.
A partial nephrectomy might not be an option if the tumor is in the middle of the kidney or is very large, if there is more than one tumor in the same kidney, or if cancer has spread to the lymph nodes or distant organs. Not all doctors can do this type of surgery. It should only be done by someone with a lot of experience.
Laparoscopic partial nephrectomy and robotic-assisted laparoscopic partial nephrectomy: Many doctors now do partial nephrectomies laparoscopically or using a robot (as described above). But again, this is a difficult operation, and it should only be done by a surgeon with a great deal of experience.
This procedure removes nearby lymph nodes to see if they contain cancer. Some doctors do this when doing a radical nephrectomy The number of lymph nodes removed may be more extensive if the tumor has characteristics suggesting it has a high risk to spread.
Most doctors agree that the lymph nodes should be removed if they look enlarged on imaging tests or feel abnormal during the operation. Some doctors also remove these lymph nodes to check them for cancer spread even when they aren’t enlarged, in order to better stage cancer. Before surgery, ask your doctor if they plan to remove the lymph nodes near the kidney.
Although this is a standard part of a radical nephrectomy, if the cancer is in the lower part of the kidney (away from the adrenal gland) and imaging tests show the adrenal gland is not affected, it may not have to be removed. Just like with lymph node removal, this is decided on an individual basis and should be discussed with the doctor before surgery.
In about 1 in 4 people with kidney cancer, cancer will already have spread (metastasized) to other parts of the body when it is diagnosed. The lungs, lymph nodes, bones, and liver are the most common sites of spread. For some people, surgery may still be helpful.
Attempts at curative surgery: In rare cases where there is only a single metastasis or if there are only a few that can be removed easily without causing serious side effects, surgery may lead to long-term survival in some people.
The metastasis may be removed at the same time as a radical nephrectomy or at a later time if cancer recurs (comes back).
Surgery to relieve symptoms (palliative surgery): When other treatments aren’t helpful, surgically removing the metastases can sometimes relieve pain and other symptoms, although this usually does not help people live longer.
The short-term risks of any type of surgery include reactions to anesthesia, excess bleeding (which might require blood transfusions), blood clots, and infections. Most people will have at least some pain after the operation, which can usually be helped with pain medicines if needed.