Surgeons most often treat kidney cancer with one of two types of surgery — radical nephrectomy or partial nephrectomy. The choice of surgery depends on the stage and location of the cancer.
Surgery is
Based on the size and location of the tumor, a surgeon might recommend surgery immediately.
In other cases, the doctor may recommend active surveillance of the tumor with frequent scans and follow-up visits. This may be the case if the patient has significant medical problems that would make surgery dangerous.
This article goes into more detail about the different types of surgery that can treat kidney cancer.
The surgeon may choose to do the surgery laparoscopically or robot-assisted.
During laparoscopic surgery, the surgeon makes several smaller incisions, about 1 centimeter (cm) long, instead of one large one. The surgeon then uses long instruments called laparoscopes to see and move within the body and carry out the surgical procedure.
Some surgeons conduct the surgery using a machine that guides mechanical arms that hold the laparoscopes. This is called robot-assisted laparoscopic surgery. These surgeons are very specially trained in this procedure.
Laparoscopic surgery
A surgeon may decide to perform open surgery. This is when they remove the tissue through a large surgical cut. The surgeon makes the incision below the ribs, which allows them to directly see the tumor and the kidney.
The National Comprehensive Cancer Network (NCCN) notes that this can take several hours and a person will need to stay in the hospital.
Partial nephrectomy is also called nephron-sparing or kidney-sparing surgery. This type of surgery removes the cancer but leaves the rest of the kidney intact, allowing for typical kidney function.
The
Surgeons often perform this procedure to remove tumors that measure less than 4 cm across. However, they may also use it to remove tumors that measure up to 7 cm across.
If the cancer is in the center of the kidney, partial nephrectomy may not be an option.
In a radical nephrectomy, the surgeon will remove the entire kidney, including the tumor. In some cases, they may also remove the adrenal gland, which is attached to the top of the kidney.
In some people whose cancer has developed in the lower part of the kidney, the surgeon
The surgeon may also perform a lymph node dissection to remove the nearby lymph nodes. However, the NCCN notes that this is not common, and a surgeon may do this only if the lymph nodes are enlarged.
A radical nephrectomy is an option if the tumor is large or has spread to the nearby tissues.
Additional surgery could be an option if cancer recurs after a first surgery,
When surgery is not an option, doctors may recommend treatment with one or more immunotherapy drugs or a combination of immunotherapy drugs and targeted therapy drugs.
When cancer has metastasized — spread to other parts of the body — a surgeon
According to the NCCN, when the kidney cancer has spread, a surgeon may perform a procedure called cytoreductive nephrectomy. This removes the primary tumor.
This is not a cure, but it can help:
- prolong life
- reduce pain
- improve quality of life
- improve the effectiveness of other treatments
People may also require radiation therapy, immunotherapy, or targeted therapy.
With any surgery, there are some risks. These can
- reactions to anesthesia
- bleeding
- blood clots
- infection
- postoperative pain
With kidney surgery, there are some particular risks, including:
- damage to nearby organs
- unwanted air in the chest cavity (pneumothorax)
- bulging of organs near the incision (an incisional hernia)
- urine leaking into the abdomen
- kidney failure if only one kidney is left
The outlook for both partial and radical nephrectomy is positive, and often the cancer goes into remission.
One
| 3-year survival rate | 5-year survival rate | |
|---|---|---|
| Partial nephrectomy | 93.6% | 78.7% |
| Radical nephrectomy | 88% | 76.2% |
Prior to the surgery, the doctor will order pre-surgical testing. This may include X-rays, electrocardiograms, blood tests, and more.
The doctor’s team will provide detailed instructions on preparation for surgery.
People may wish to think about the following before surgery:
- who the primary caregiver following the procedure will be
- transportation to get back from the hospital
- any medications or supplements that a person is taking, which they should discuss with a doctor
People should aim to wear loose, comfortable clothes to the surgery center.
If a person has not already done so, they may wish to fill out an advanced directive, also called a living will. These forms name a person who can make decisions for an incapacitated person. A person can find these online, or a doctor’s office can help provide direction on where to find them.
After a person wakes from surgery, a nurse will provide some advice on how best to begin recovery.
The doctor will provide some medication for pain management. If the pain is too high, a person should let the healthcare team know.
A person should call the healthcare team if they:
- have swelling or tenderness in the calves or thighs
- experience shortness of breath
- are coughing up blood
- have a fever higher than 101°F
- have blood in their urine
Follow-up times
After surgery, a person will have follow-up appointments to check for signs that the cancer is returning.
The NCCN provides the following guidelines:
| Kidney cancer stage | Follow-up care |
|---|---|
| Stage 1a and 1b | • health history and physical exam every year • CT or MRI scans within 3–12 months, and then once a year for 3 years • chest X-ray or CT scan each year for 5 years |
| Stage 2 and 3 | • health history and physical exam every 3–6 months for 3 years, and then each year for 5 years • metabolic and panel tests every 3–6 months for 3 years, and then each year for 5 years • abdominal CT scan or MRI scan in 3–6 months, followed by every 3–6 months for 3 years, and then once a year for 5 years • CT scans of the chest within 3–6 months, followed by every 3–6 months for 3 years, and then once a year for 5 years |
| Stage 4 | • health history and physical exam every 6–16 weeks • CT or MRI scans every 6–16 weeks • other scans as needed to check other areas of the body |
Depending on the function of the kidneys after surgery, a person should not need to make any dietary restrictions. However, a person may be referred to a nephrologist, who can provide more information about any necessary dietary changes.
Activity
The United Kingdom’s National Health Service (NHS) notes that after keyhole surgery, it can take 4–6 weeks for a person to return to their previous typical fitness levels. This can take a few months for those who have open surgery.
For 6 weeks, people should avoid:
- taking long walks
- climbing lots of stairs
- gardening
- running
- cycling
- lifting heavy objects
People should avoid those activities for 2–3 months following open surgery.
Mental health help and support groups
It is always a good idea to let family, friends, and the healthcare team know when frustrations, sadness, or fears arise.
Support groups and resources are available. A few options include:
- CancerCare: People can call 800-813-4673 or email info@cancercare.org.
- Kidney Cancer Association: People can email patients@kidneycancer.org.
- Stanford Bladder and Kidney Cancer Support Group: People can call 650-308-6274.
Before the surgery, people may wish to ask the
- What type of kidney cancer do I have?
- Where is the cancer?
- Has the cancer spread?
- What stage is the cancer?
- Do I need to see specialists?
- What is the goal of treatment?
- How quickly do we need to decide on treatment?
- What risks or side effects are there to this treatment?
- What if the treatment does not work?
- How much experience do you have with this type of cancer?
Following surgery, people may wish to ask:
- Are there limits on what I can do?
- What if I am in pain?
- How often do I have follow-up appointments?
- What kind of exercise should I do?
- Do I need a special diet?
- When can I go back to work?
- When will we know if the cancer has come back?
Several organizations work to provide financial relief for those facing a cancer diagnosis. These include:
- the Kidney Cancer Association’s Patient Assistance Fund
- CancerCare’s Co-Payment Assistance Fund
- American Kidney Fund’s Assistance Program
- Healthwell Foundation’s Medicare Access Program
Surgery for kidney cancer may be laparoscopic, robot-assisted laparoscopic, or open. It will involve removing either the entire kidney and the surrounding tissues or a part of the kidney.
If a surgeon performs a radical nephrectomy, they may also remove the adrenal gland. If the tumor is in the center of the kidney, a partial nephrectomy may not be an option.
Following surgery, a person may need to make some dietary and lifestyle changes. Surgery for kidney cancer is generally successful with good results.