Surgery for Kidney Cancer

Surgery is often part of treatment for kidney cancer. It is sometimes the only treatment needed, especially for cancers that are still only in the kidney.

The type of surgery your care team recommends will depend on the stage and location of your cancer, as well as other factors.

Types of surgery for kidney cancer

A few types of surgery might be recommended for someone with kidney cancer.

To remove tumors in the kidney:

• Radical nephrectomy removes the entire kidney.
• Partial nephrectomy removes only the part of the kidney with the tumor.
• Enucleation removes a kidney tumor without cutting into healthy tissue. It is used in limited situations.

To remove nearby lymph nodes:

• Lymphadenectomy or lymph node dissection removes lymph nodes, if needed. This might be done to see if cancer cells have spread.

If the cancer has spread (metastasized):

• Surgery to remove tumors in another part of the body is sometimes an option.
• Tumors might also be removed to help with symptoms such as pain or bleeding.

Radical nephrectomy

For a radical nephrectomy, the surgeon removes the kidney, nearby fat, and Gerota’s fascia around the kidney. Nearby lymph nodes or the adrenal gland on top of the kidney are sometimes removed as well, especially if there is a high risk of the cancer spreading there.

This surgery can be done in a few ways:

Partial nephrectomy (nephron-sparing surgery)

A partial nephrectomy might be a good option for some people with early-stage kidney cancer.

In a partial nephrectomy, the surgeon removes only the part of the kidney that contains the cancer, along with a rim of healthy kidney tissue. The rest of the kidney is left in place. Lymph nodes and the adrenal gland are not often removed.

This surgery can be done in a few ways:

Partial vs. radical nephrectomy

Not everyone can have a partial nephrectomy. But in people who are good candidates, studies show the long-term outcomes after treatment from kidney cancer are about the same for a partial nephrectomy compared to surgery that removes the whole kidney.

The benefit of a partial nephrectomy is that you keep more kidney tissue and function. A potential risk is that the cancer might not be removed completely. In some cases, a partial nephrectomy might need to be changed to a radical nephrectomy. This depends on what is found during surgery.

Partial nephrectomy is typically a more complex surgery than a radical nephrectomy. It should only be done by a surgeon with experience.

Who qualifies for this surgery?

Your cancer care team will consider multiple factors to decide if you qualify for this type of surgery.

A partial nephrectomy might be a good option if:

• The kidney tumor is smaller, usually less than about 10 centimeters across (about 4 inches).
• The tumor is not in the central part of the kidney.
• You already have reduced kidney function* or you are likely to have reduced function in the future.

*For example, you might have reduced kidney function if you only have one working kidney, have tumors in both kidneys, are at risk for some type of chronic kidney disease, or have an inherited (hereditary) condition that increases your risk of more kidney tumors later on.

A partial nephrectomy might not be an option if:

• The tumor is very large.
• The tumor is in the central part of the kidney.
• There is more than one tumor in the same kidney.
• The tumor has reached the renal vein or inferior vena cava, or the cancer has spread to the lymph nodes or distant organs.

Enucleation

Enucleation is a surgery to remove a kidney tumor without cutting into normal kidney tissue. This surgery is not used very often. It might be considered in people with:

• Multiple kidney tumors
• Low kidney function
• A family cancer syndrome that increases the risk of other kidney tumors in the future

Lymph node removal

Your cancer care team may need to remove one or more lymph nodes to see if they contain cancer cells. This procedure is called a lymphadenectomy or lymph node dissection. When it is needed, it is usually done at the same time as the surgery to remove the kidney tumor.

You might need lymph node removal for one of the following reasons:

• There is a high risk of the kidney cancer spreading to your nodes.
• One or more nodes look enlarged on imaging tests.
• One or more nodes feel abnormal during surgery.

As part of staging, doctors might also remove lymph nodes to check them for cancer spread even if they are not enlarged. The cancer’s stage could affect whether or not you need more treatment after surgery.

Removal of metastases

Sometimes, kidney cancer has already spread (metastasized) to other parts of the body by the time it’s found. The most common places kidney cancer spreads are the lungs, lymph nodes, bones, and liver. Surgery to remove these tumors may be helpful for some people.

If the cancer has spread to only a few spots outside the kidney, it is possible that a surgeon might remove them as a part of treatment. When tumors outside of the kidney can be removed completely and safely, it might improve the prognosis (outlook) for the cancer.

If the cancer has spread to many spots outside the kidney, surgery is not likely to be able to remove the cancer completely. But in some cases, surgery might be done as a part of supportive care. Removing these tumors might improve symptoms, such as pain.

Risks and side effects of surgery for kidney cancer

The short-term risks of any type of surgery include reactions to anesthesia, infections, blood clots, and bleeding, which might require blood transfusions. Most people will have at least some pain after surgery. This can usually be treated with pain medicines, if needed.

Other possible risks of surgery for kidney cancer include:

• Damage during surgery to organs and blood vessels, including the spleen or liver, pancreas, aorta, vena cava, or large or small bowel
• Pneumothorax (air in the chest space around the lungs)
• Hemothorax (blood in the chest space)
• Incisional hernia (bulging of internal organs near the surgical incision due to problems with wound healing)
• Urine leaking into the abdomen after partial nephrectomy
• AV fistula (an abnormal connection between an artery and vein)
• Kidney failure, if the remaining kidney fails to function well

If you are placed on cardiopulmonary bypass (a heart and lung machine) during surgery, this has additional risks. The procedure can affect your blood salt levels and blood flow to your heart and brain during surgery. Talk to your surgeon and anesthesia team before your surgery to discuss these specific risks.

Ask your care team what to expect after surgery. You might want to ask about your recovery time, any limits on what you can do, common side effects to watch out for, and when to contact your care team if you are having problems.