Surgery is the main treatment for most renal cell carcinomas. The chances of surviving a renal cell cancer without having surgery are small. Even patients whose disease has spread to other organs may benefit from surgery to take out the kidney tumor.. Depending on the stage and location of the cancer and other factors, surgery may be used to remove either the cancer along with some of the surrounding kidney tissue, or the entire kidney. The adrenal gland (the small gland that sits on top of each kidney) and fatty tissue around the kidney may be removed as well.

Radical nephrectomy

The most common operation to treat renal cell cancer is called a radical nephrectomy. In this operation, the surgeon removes your whole kidney, the attached adrenal gland, and the fatty tissue around the kidney. (Most people do just fine with only the one remaining kidney.)

The surgeon can make the incision in several places. The most common sites are the middle of the abdomen (belly), under the ribs on the same side as the cancer, or even in the back, just behind the cancerous kidney. Each approach has its advantages in treating cancers of different sizes and in different locations in the kidney.

Laparoscopic nephrectomy

For some doctors, this approach to radical nephrectomy has quickly become, a preferred method for removing kidney tumors.

The operation is done through several small incisions (which is why it is sometimes called "keyhole" surgery) as opposed to one large one. Special long instruments are inserted through the incisions, each of which is about 1/2-inch long, to perform the operation. One of the instruments has a small video camera on the end, which allows the surgeon to see inside the abdomen. Usually, one of the incisions has to be made longer in order to remove the kidney (although it's not as long as the incision for a standard nephrectomy).

This approach can be used to treat most renal tumors that cannot be treated with nephron-sparing surgery (see below). In experienced hands, the technique is thought to be as effective as open radical nephrectomy and usually means a shorter hospital stay, a faster recovery, and less pain after surgery.

Regional lymphadenectomy (lymph node dissection)

This procedure removes nearby lymph nodes to see if they contain cancer. Many doctors do this along with the radical nephrectomy, although not all doctors agree that it is necessary. The main reason for doing it is to try to more accurately stage the cancer by determining if it has reached the lymph nodes (instead of relying only on imaging study results). This can be important for predicting chances for survival and deciding on further treatment options. In theory, removing the lymph nodes might also increase the chances that all of the cancer is removed, but this has not been proven. Patients who have localized kidney cancer may be spared lymph node removal if imaging tests do not suggest lymph node involvement,, however, this is an important issue to discuss with your doctor before surgery.

Removal of an adrenal gland

If imaging tests show the adrenal gland is not affected, it may not have to be removed. Again, similar to lymph node removal, this is decided on an individual basis and should be discussed with the doctor before surgery.

Partial nephrectomy (nephron-sparing surgery)

In this procedure, the surgeon removes only the part of the kidney containing cancer, leaving the rest of the organ behind. As with a radical nephrectomy, the surgeon can make the incision in several places, depending on factors like the location of the tumor.

This approach is used most often when there is a need to save some of the remaining kidney function, such as in people with cancer in both kidneys, those who only have one kidney and develop cancer in that kidney, or in people who already have reduced kidney function for some other reason. It may also be used to try to preserve as much kidney function as possible in people who are more likely to develop other kidney cancers in the future, such as those with von Hippel-Lindau disease.

A partial nephrectomy may also be done in patients with a single kidney cancer that is smaller than 4 cm (about 1¾ inch) across. This procedure is being done more in patients with tumors up to 7 cm across. Studies have shown the long-term results to be about the same as for removing the whole kidney. The obvious benefit is that the patient retains more of their kidney function. Partial nephrectomies are generally not done for larger tumors, if there is more than one tumor in the same kidney, or if the cancer has spread to the lymph nodes or distant organs.

Some doctors at major medical centers are now studying whether laparoscopic partial nephrectomy is a possible option. But it is a difficult operation, and it is generally thought of as an investigational procedure at this time.

Removal of metastases

About 1 out of 4 patients with renal cell carcinoma will already have metastatic spread of their cancer when they are diagnosed. The lungs, bones, brain and liver are the most common sites of spread. In some patients, surgery may still be helpful.

Attempts at curative surgery: 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 may lead to long-term survival in some people. The metastasis may be removed at the same time as a radical nephrectomy or at a later time if the cancer recurs (comes back).

Surgery to relieve symptoms (palliative surgery): When other treatments aren't helpful, surgically removing the metastases can sometimes relieve pain and other symptoms, although this usually does not help patients live longer.

Risks of surgery

Risks of surgery include:

• bleeding during surgery or after surgery that may require blood transfusions
• wound infection
• damage to internal organs and blood vessels (such as the spleen, pancreas, aorta, vena cava, large or small bowel) during surgery
• pneumothorax (unwanted air in the chest cavity)
• incisional hernia (bulging of internal organs near the surgical incision due to problems with wound healing)
• kidney failure (if the remaining kidney fails to function well)

Last Medical Review: 02/18/2009
Last Revised: 05/14/2009