Partial Nephrectomy

Kidney Cancer: Surgery

Surgery is the most common treatment for kidney cancer. The goal is to take out the tumor or tumors. You may have radiation or other treatment before or after surgery.

When might surgery be used to treat kidney cancer?

Your healthcare provider may advise surgery to treat your kidney cancer if any of the following apply to you:

  • You are healthy enough to have surgery. Your healthcare provider will only suggest surgery if he or she expects you to be able to recover from it.

  • The tumor is small. In this case, your healthcare provider may do a partial nephrectomy. This surgery allows you to keep some kidney function. Only the part of the kidney that contains the tumor is taken out. This surgery may be done if the tumor is larger, but you have cancer in both kidneys or if you have only one kidney. The benefit is that you keep part of the kidney. The risk is that there is a chance some cancer cells will be left behind.

  • The tumor is larger, but is only in your kidney. Your healthcare provider will advise the type of surgery you need based on the size and location of the tumor. Your healthcare provider may advise a simple nephrectomy. This is surgery to take out the entire kidney. Or your health care provider may advise a radical nephrectomy. This is surgery to take out the whole kidney and the adrenal gland. The adrenal gland is attached to the top of the kidney. Much of the nearby fatty tissue is also taken out. Nearby lymph nodes will also likely be removed. That's because cancer may travel to the nodes first. Taking out the lymph nodes may help prevent cancer from spreading to other parts of your body. And examining these lymph nodes helps determine the stage of the cancer. This is important in deciding if other treatments are needed after surgery.  

  • You have kidney cancer that has spread to only 1 other area. Your healthcare provider may suggest a radical nephrectomy and removal of nearby lymph nodes, as well as removal of the tumors in other parts of the body. There are cases where surgery won’t cure the cancer. But even in those cases, surgery can sometimes help ease symptoms, such as pressure, pain, or bleeding.

  • You have symptoms. You may have pain, pressure, or bleeding from tumors that have spread. Your healthcare provider may suggest surgery to remove the tumors. This is done to ease symptoms. Because it doesn't cure the cancer, it is called palliative therapy.

Types of surgery

Kidney cancer surgery may be done in several ways:

  • Open surgery. This is done using a large cut (incision). The incision is made in the belly (abdomen). Or it is made in your side or your back. One of the lower ribs may need to be removed to give access to the kidney. The healthcare provider then uses tools through this incision to do the surgery.

  • Laparoscopy. This type of surgery uses several small incisions. It’s done with a thin, flexible tube with a light and camera called a laparoscope. The scope is put into 1 incision. Small tools are put into the other incisions. Laparoscopy often leads to less time in the hospital after surgery. It often has less pain, less scarring, and a faster recovery.

  • Robotic surgery. This type of surgery uses robot arms guided by a healthcare provider on a computer. It is only done at certain surgery centers. This type of surgery uses smaller incisions and may lead to less pain and scarring after surgery. 

Risks of kidney cancer surgery

All surgery has risks. The risks of kidney surgery include:

  • Excess bleeding

  • Infection

  • Damage to nearby internal organs

  • Bulging of organs under the incision (incision hernia)

  • Air in the chest cavity (pneumothorax)

  • Kidney failure of the remaining kidney

Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you.

Getting ready for your surgery

Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask about:

  • What type of surgery will be done

  • What will be done during surgery

  • The risks and possible side effects of the surgery

  • If you will have kidney function after surgery

  • When you can go back to doing your normal activities

  • If the surgery will leave scars and what they will look like

Before surgery, tell your health care team if you are taking any medicines. This includes over-the-counter medicines, vitamins, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form that says that the health care provider can do the surgery.

You’ll also meet the anesthesiologist and can ask questions about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you the anesthesia so that you fall asleep and don’t feel pain.

After your surgery

You will wake up in a recovery room. You will be watched closely as you fully wake up and are able to talk to the nurses. You may have to stay in the hospital for 2 to 7 days, depending on the type of surgery you had. For the first few days after surgery, you are likely to have pain from the incision. Your pain can be controlled with medicine. Talk with your healthcare provider or nurse about your options for pain relief. Some people don’t want to take pain medicine, but doing so can help your healing. If you don’t control pain well, for example, you may not want to cough or turn over often, which you need to do as you recover from surgery.

You will likely have a urinary catheter for a few days. This a tube put through your urethra and into your bladder so that your urine goes into a bag outside your body. In some cases, you may go home with the catheter still in.

You may have diarrhea. Talk with your healthcare provider, nurse, or a dietitian about what you can eat to reduce the chance of getting diarrhea. You may have constipation from using some pain medicine, from not moving much, or from not eating much. Talk with your healthcare provider or nurse about getting more dietary fiber or the use of a stool softener.

Recovering at home

When you get home, you may get back to light activity, but you should avoid strenuous activity for 6 weeks.

You may feel tired or weak for a while. The amount of time it takes to recover from surgery is different for each person. But you will probably not feel like yourself for a few months. You will be able to get your incision wet in the shower. But to reduce your risk of infection, don’t take baths or go swimming. You may not be able to drive until your healthcare provider says it's OK.

Your healthcare team will tell you what kinds of activities are safe for you while you recover.

Follow-up care

You may need radiation treatment after surgery. Your healthcare provider will talk with you about this type of treatment and when it will start.

When to call your healthcare provider

You may need to take medicine when you go home, such as pain medicine. It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how to take them, how they work, what they're for, and what side effects they might have.
Talk with your healthcare providers about what problems to watch for and when to call them.
Let your healthcare provider know right away if you have any of these problems after surgery:

  • Bleeding

  • Redness, swelling, or fluid leaking from the incision

  • Fever

  • Chills

Make sure you know what number to call with problems or questions. Is there a different number for evenings and weekends?

Kidney Cancer: Treatment Choices

There are various treatment choices for kidney cancer. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Factors also include your age, overall health, and what side effects you’ll find acceptable.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

The healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than 1, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process. 

Understanding the goals of treatment for kidney cancer

Treatment may control or cure the kidney cancer. It can also improve your quality of life by helping to control the symptoms of the disease. The goal of kidney cancer treatment is to do 1 or more of these things:

  • Remove the primary kidney cancer tumor or other tumors

  • Kill or stop the growth or spread of kidney cancer cells

  • Prevent or delay the cancer's return

  • Ease symptoms of the cancer, such as pain or pressure on organs

Types of treatment for kidney cancer

Treatment options include:

  • Surgery. Surgery to remove the kidney is called a nephrectomy. Surgery is used to remove the kidney with the tumor and any nearby lymph nodes that contain cancer. You may also have surgery to ease pressure or pain. The remaining kidney is often able to do the work of both kidneys.

  • Biologic therapy. This is also known as immunotherapy. It uses medicines that work like chemicals that your body’s immune system makes. They help your immune system fight the cancer.

  • Radiation therapy. This treatment kills cancer cells with high-energy X-rays. Radiation is most often used when the kidney cancer has spread to certain bones or the brain. It may be used to treat symptoms such as cough or pain.

  • Chemotherapy. This treatment uses 1 or more medicines to kill cancer cells or shrink tumors. They work by attacking rapidly growing cells. Regular chemotherapy medicines are not often very effective against kidney cancer.

  • Targeted therapy. These are medicines that target specific parts of kidney cancer cells to kill them or slow their growth. These medicines work differently from regular chemotherapy medicines. They’re often used to treat advanced kidney cancer.

  • Ablation therapy. There are 2 main types of ablation therapy used to treat kidney cancer. They’re both done by putting a needle into an area of cancer cells. This is a less-invasive treatment that causes less bleeding. It also keeps the side effects to a small area of the body. Radiofrequency ablation (RFA) uses energy waves to kill cancer cells. Cryoablation uses extreme cold to kill cancer cells.

  • Supportive care. Your healthcare provider may advise therapies that help ease your symptoms, but don’t treat the cancer. Your healthcare provider may suggest supportive care if he or she believes that available treatments are more likely to do you more harm than good.

Your healthcare provider may suggest that you have more than 1 of these types of treatment. This is sometimes called combination therapy. Newer types of treatment may be available only through a research study. This is called a clinical trial. Talk with your healthcare provider about what clinical trials may be an option for you.