Kidney Cancer (Adult) Renal Cell Carcinoma Overview

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Treating Kidney Cancer TOPICS

Surgery for kidney cancer

Surgery is the main treatment for renal cell cancer. The chances of surviving kidney cancer without surgery are small. Depending on the type and stage of your cancer, you might have one of the types of surgery below.

Radical nephrectomy

In this operation, the whole kidney, the attached adrenal gland, and some nearby fatty tissue are removed. Although the adrenal gland is usually removed, 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. Nearby lymph nodes are sometimes removed, too. This is called regional lymphadenectomy. Most people do fine with only one kidney.

If the tumor has grown from the kidney through the renal vein (the large vein leading away from the kidney) and into 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 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.

“Keyhole” surgery (laparoscopic nephrectomy)

In this surgery, the kidney tumors are removed through small incisions (cuts) in the skin instead of through one large incision. The surgeon can put special long, thin instruments in the cuts to see the kidney and do the surgery. The benefits include a shorter hospital stay, faster recovery, and less pain afterwards.

Partial nephrectomy

This is also called nephron-sparing surgery. The surgeon removes only the part of the kidney with the cancer. The rest is left in place. At first, this approach was only used when there was a reason not to remove the whole kidney. But this type of surgery is now the preferred treatment for patients with early stage kidney cancer. It is often done to remove single small tumors and is being done more in patients with larger tumors.

A partial nephrectomy may 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 the cancer has spread to the lymph nodes or distant organs. Not all doctors are able to do this type of surgery. Some doctors can even do this surgery laparoscopically or using a robot. This is more common at major medical centers. But it is a difficult operation, and it should only be done by a surgeon with a great deal of skill and who has done the operation often.

Removing lymph nodes (lymph node dissection or regional lymphadenectomy)

This method involves removing nearby lymph nodes to see if they contain cancer. Some doctors do this along with the radical nephrectomy although not all doctors agree that it is always needed. Most doctors agree that the lymph nodes should be removed if they are enlarged based on imaging tests or how they look 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 the cancer. This is something you should discuss with your doctor before surgery.

Removal of an adrenal gland

If the cancer is in the lower part of the kidney (away from the adrenal gland) and if imaging tests show the adrenal gland is not affected, it may not have to be removed. This is also something to talk about with your doctor before surgery.

Removal of metastases

Sometimes surgery is done to remove cancer that has spread. This can help relieve pain or other symptoms even though it does not usually help patients live longer. It is most often done if there are only a few tumors that can be removed easily. The lungs, bones, brain and liver are the most common sites of spread.

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 to remove them can help people live longer.

Risks of surgery

Surgery always involves some risks. Here are some possible risks of surgery for kidney cancer:

  • Bleeding during or after surgery that may require blood transfusions
  • Wound infection
  • Damage to internal organs and blood vessels during surgery
  • Unwanted air in the chest cavity
  • Bulging of nearby internal organs into the incision (hernia)
  • Failure of the remaining kidney

Last Medical Review: 11/27/2012
Last Revised: 04/01/2014