Description of the Procedure

The surgeon makes an incision under the ribs or in the back just behind the kidney. Then the surgeon removes the whole malignant kidney (radical nephrectomy) or a portion of the cancerous kidney (partial nephrectomy). He or she may also remove the adrenal gland; one adrenal gland sits above each kidney. Nearby lymph nodes may also be taken out. The incision is closed with stitches or staples, and bandaged to prevent infection.

Generally, this has been an open procedure. But the laparoscopic approach has become the preferred method to treat kidney cancer if suitable. With this method, small incisions are made in the skin through which a camera, light source, and surgical instruments are inserted. The surgeon performs the surgery using these tools, without cutting open the abdomen or back. With the laparoscopic approach you should have a faster recovery and spend only a couple of days in the hospital. Open surgery is still performed, usually for larger tumors that require more extensive surgery. You will stay in the hospital for four to seven days.

Effectiveness

Nephrectomy is very successful. It has a five-year survival rate of 94% for patients with Stage I disease. For Stage II, it offers a five-year survival rate of 79%. The survival rate varies for Stage III, depending on where and how extensively the cancer has spread.

Possible Complications

• Bleeding
• Infection
• Damage to other internal organs or blood vessels during the procedure
• Reaction to anesthesia
• Collection of air or gases in the lung cavity (pneumothorax)
• Kidney failure, if the remaining kidney does not function well

Postoperative Care

After surgery, you may need certain interventions:

• Urinary catheter—A tube is passed through the urethra into the bladder to measure urine output and avoid the need to urinate in the bathroom.
• Medications—You may be given antibiotics, pain medication, or antinausea drugs after surgery.
• Coughing and deep breathing exercises—Your nurse or respiratory therapist will show you how to do these exercises, which are usually done 3-4 times daily to help keep your lungs clear.

In the hospital and after you leave:

• Get out of bed often and sit in a chair. Increase your activity as much as tolerated.
• Stay well hydrated.
• Avoid environments and people that expose you to germs, smoke, or chemical irritants.

Call Your Doctor If Any of the Following Occurs

• Difficulty breathing
• Stitches or staples come apart
• Bandage becomes soaked with blood
• Coughing up mucus that is yellow, green, or bloody
• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
• Cough, shortness of breath, chest pain, or severe nausea or vomiting