Radical Nephrectomy

What is the purpose of a radical nephrectomy?

Doctors use radical nephrectomy to treat stage 1–3 kidney cancer, often with the goal of curing the cancer. They may also use a procedure called a radical cytoreductive nephrectomy to reduce the symptoms and spread of cancer in people with stage 4 kidney cancer.

Stage 1

Doctors usually perform either a radical or simple nephrectomy to treat stage 1 kidney cancer.

Unlike a radical nephrectomy, a simple nephrectomy involves removing your kidney but not the surrounding tissue. Some surgeons believe that radical nephrectomy yields better results, but this is still under investigation.

For tumors smaller than 4 centimeters (about 1.5 inches) wide, doctors may recommend a partial nephrectomy.

Stage 2

For stage 2 kidney cancer, doctors may perform a radical nephrectomy alone or in combination with use of the targeted therapy drug pembrolizumab (Keytruda). Doctors usually give this drug to people who have a high risk of cancer spread.

Doctors may give radiation therapy before or after a radical nephrectomy to shrink the tumor or destroy cancer cells that surgery might have missed.

Partial nephrectomy may also be an option for smaller tumors in stage 2.

Stage 3

To treat stage 3 kidney cancer, doctors may recommend a radical nephrectomy only. They may also recommend that you follow the surgery with the targeted therapy drugs pembrolizumab or sunitinib (Sutent).

You may receive embolization or external beam radiation therapy before a radical nephrectomy.

Stage 4

Doctors may perform a cytoreductive radical nephrectomy to treat stage 4 kidney cancer. They may combine it with immunotherapy or targeted therapy drugs. The development of these drugs has reduced the need for cytoreductive nephrectomies.

What happens during a radical nephrectomy?

Doctors can perform a radical nephrectomy through a large incision (open surgery) or through several small incisions with the help of a small camera (laparoscopic surgery).

Laparoscopic surgery generally has a shorter recovery period. You can expect to stay in the hospital for about 5 days.

Here’s a general idea of what you can expect:

1. You’ll receive intravenous (IV) general anesthesia, usually through a vein in your arm. This puts you to sleep during your procedure.
2. Once you’re asleep, your surgical team will position you on the operating table according to the technique your surgeon will be using. The flank technique involves placing you on your side and making an incision near your bottom rib. The anterior approach involves making incisions in the front of your abdomen.
3. Your surgeon will remove your kidney and the surrounding tissue through the incision. They may also remove lymph nodes.
4. The surgical team will close your wounds with dissolvable stitches and cover them with bandages.

What are the risks of radical nephrectomy?

Every surgery comes with some risks. The risks of radical nephrectomy include:

• pain around your incision
• abdominal bloating
• bleeding that may require a transfusion
• hernia
• injury to organs or blood vessels
• reactions to the anesthesia
• cardiovascular problems such as:
  • chest infection
  • blood clot in your lung
  • stroke
  • deep vein thrombosis
  • heart attack
  • death, in fewer than 1% of cases

What can I expect during recovery after a radical nephrectomy?

You’ll likely wake up in the recovery area after your procedure with an IV drip and a catheter in your bladder. You’ll be able to drink clear fluids immediately but may have to wait 1–3 days before eating. Your catheter will likely be removed once you can walk.

It will take about 14 days for your skin wound to heal. However, full recovery may take 2 months. To reduce the risk of blood clots, healthcare professionals often recommend wearing elasticated stockings for 2 weeks after you leave the hospital.

How do I prepare for a radical nephrectomy?

You’ll have many tests before your procedure to check your fitness. These tests include:

• blood tests to check your overall health and kidney function
• a chest X-ray to check your lung function
• an electrocardiogram to check your heart health

About a week before your procedure, you’ll likely have a pre-assessment where you’ll meet your treatment team and sign consent forms. You’ll also have an opportunity to ask any questions you may have.

What is the outlook for people after radical nephrectomy?

In a 2019 study, researchers found that 45% of people recovered to their preoperative estimated glomerular filtration rate (eGFR) within 2 years after radical nephrectomy. Your eGFR is a measure of how much blood your kidneys filter each minute.

According to a 2020 research review, people with low grade kidney tumors are likely to live for 5 years or more without signs of kidney cancer recurrence. The authors noted that recurrence-free survival was 86–91% after open radical nephrectomy and 92–95% after laparoscopic radical nephrectomy.

But your life expectancy after nephrectomy will also depend on other factors, such as the stage of your cancer. A 2019 study found that people lived for 1–25 years after nephrectomy, with a median of 14.6 years.

In a 2021 study, researchers found that the death rate increases when radical surgery is delayed more than 60 days.

Takeaway

A radical nephrectomy is surgery to remove your kidney to treat cancer that is limited to your kidney or the surrounding area. It can potentially cure your cancer but may cause side effects such as infection and severe bleeding.

It’s a good idea to ask your healthcare team any questions you may have before your procedure so you know what to expect. Questions you may want to ask include:

• What are the potential side effects I might experience?
• What are the chances of curing my cancer?
• Are there any other treatment options?