Surgery is the first choice of treatment for many kidney cancers. Deciding whether to have surgery will happen after completing initial testing for diagnosis and after discussion with a surgeon. You may also consider getting a second opinion from another kidney cancer specialist before opting for surgery. A second opinion will not change your diagnosis but it may give you useful information and treatment alternatives, such as clinical trials. If surgery is done first, additional treatment may be recommended to delay the cancer’s return or to treat metastatic disease.
A variety of surgical procedures can be considered depending on the type and size of the tumor, the extent of disease, and the patient’s overall physical condition. You and your doctor should discuss the surgical options that are appropriate for you.
Removing All or Part of the Kidney (Nephrectomy)
The treatment of many kidney cancers begins by removing the primary tumor in an operation called a nephrectomy. The purpose of surgery is to remove the primary tumor and involved tissue in the kidney. Even if the cancer has already spread, a nephrectomy may still be beneficial because your body then has less cancer to eliminate through treatments that your doctors might recommend after surgery.
Though nephrectomy is the most common treatment for kidney cancer, it may not be appropriate in some cases. Your urologist can help explain the factors that influence whether to proceed with nephrectomy.
There are two basic types of nephrectomies for kidney cancer. A partial nephrectomy involves removing just the part of the kidney that contains the tumor. A radical nephrectomy involves removal of the entire kidney and often the removal of the adrenal gland above the kidney, the surrounding fatty tissue, and the lymph nodes adjacent to the kidney.
Laparoscopy and Other Minimally Invasive Procedures
Minimally invasive surgeries involve the use of a laparoscope, an instrument that is passed through a series of small incisions or “ports” in the abdominal wall to reach the internal organs. Laparoscopy can be used for both radical and partial nephrectomies and accomplishes the same results as previous traditional surgical techniques that required larger openings in the abdominal wall.
Laparoscopic radical or partial nephrectomy can result in decreased blood loss, shorter hospital stays, less need for narcotic pain medication, and shorter recovery time when compared with open radical nephrectomies.
Cryosurgery and radiofrequency ablation (RFA) may be used to destroy small kidney tumors in select patients. Cryosurgery, or cryoablation, uses freezing temperatures (achieved by using liquid nitrogen or carbon dioxide) to destroy diseased tissue. RFA destroys tumors with thermal energy (heat). These procedures can be done without an incision by passing tiny probes directly through the skin into the tumor under x-ray guidance.
The Role of Nephrectomy in Advanced Disease
Nephrectomy has become an integral part of managing patients with metastatic kidney cancer. Performing nephrectomy in patients with advanced kidney cancer is not without risk. The chance of metastatic disease progression during the postoperative period or complications before or during surgery prolonging postoperative recovery could potentially delay or prevent the administration of systemic therapy. Patients with complicating factors including extensive metastases to the liver, brain, or bones may not be good candidates for surgery because of their poor overall prognosis.
The tumor tissue removed during surgery is important to you as a cancer patient and for cancer research. The tumor tissues provide important information to your doctors about your specific cancer type to determine further treatment or contribute to research.
What to Expect
If your doctor recommends a nephrectomy, be sure to discuss your questions and concerns with your surgeon. Your surgery should be performed in a hospital or medical center that is experienced in dealing with kidney cancer. Your surgeon should be a board-certified urology surgeon.
The nurses at the KCA’s Nurse Line can help identify board-certified specialists near you.
Your surgeon will provide you instructions to restrict your diet – taking in only clear liquids, for example – and cleanse your bowels (enema or liquid to drink). These instructions are based on the type of surgery and the surgeon’s preference.
You will receive instructions from the anesthesiologist on dietary and medication restrictions for the morning of your surgery.
When you arrive in the “pre-op” area, the anesthesiologist will prepare you for surgery. Different anesthesia techniques can be used to keep you free from pain during your recovery from surgery. These will be discussed prior to surgery.
After the surgeon has completed the procedure, the incision is closed and a dressing is applied. You will spend some time in a surgical recovery room where you will be monitored as you wake up from the effects of the anesthetic gases.
Depending on the extent of your surgery, you may begin your recovery in intensive care where you can be closely monitored for several days, or you may be transferred to a hospital room.
Your time in the hospital depends mainly on the type of surgery performed.
Laparoscopic Nephrectomy 1-2 days
Partial Nephrectomy 4-5 days
Radical Nephrectomy 5-7 days
It will be important to get out of bed and walk to prevent blood clots, pneumonia, and wake up your bowels. The medical staff will assist you with getting out of bed to sit up in the chair and to walk several times a day.
Your dressing will be removed within 24 hours after surgery and you will be able to shower. Once your bowels wake up (passing of gas), you will be allowed to start drinking fluids and slowly start to eat solid food.
When discharged from the hospital, you will be provided with pain medication and stool softeners. Your medical team will provide you with instructions regarding any restrictions on activity, diet, etc. It is important to follow what the medical team advises.
Recovery will take about 4-8 weeks depending on the type of surgery and the individual patient.
A post-operative appointment will be scheduled per the physician’s preference.