Radical Nephrectomy

What is radical nephrectomy surgery?

A radical nephrectomy is a type of nephrectomy. During a radical nephrectomy, a surgeon removes your entire kidney, along with the fat that surrounds it. In some cases, the surgeon will also remove your adrenal gland and the lymph nodes around your kidney.

“Nephro” means “kidney,” and “ectomy” means “removal.” Even though most people have two kidneys at birth, you can live with only one, as long as it’s functioning well.

What does a radical nephrectomy treat?

Most people have a radical nephrectomy to remove a kidney tumor. But a healthcare provider may also recommend a radical nephrectomy if:

• You get a lot of kidney infections.
• Your kidney doesn’t work anymore.
• You need to treat other kidney diseases or injuries.
• You’re donating a kidney.

How common are radical nephrectomies?

A radical nephrectomy is a common procedure. Surgeons perform thousands of nephrectomies each year in the U.S.

Is a radical nephrectomy a major surgery?

Yes, a radical nephrectomy is a major surgery. You’ll stay in the hospital at least overnight after surgery. But you may need to remain for several days, depending on the type you have. Surgeons now commonly use a minimally invasive approach to perform most radical nephrectomies. This allows for a faster discharge (release from the hospital).

How should I prepare for a radical nephrectomy?

Before a radical nephrectomy, your healthcare provider may conduct a blood test to determine your baseline kidney function and blood type. They need to know your baseline kidney function to predict what your kidney function will be after surgery. In addition, testing will determine your blood type in case you need a blood transfusion during or after surgery, which is uncommon. They’ll also conduct a physical examination to check your general health, including your temperature, pulse and blood pressure.

Tell your provider about any prescription or over-the-counter (OTC) medications you’re taking, including herbal supplements. Some herbal supplements and OTC medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and blood thinners (anticoagulants), can increase your risk of bleeding.

You should also tell your provider about any known allergies, including:

• Medication allergies
• Latex allergies
• Skin cleaners, like iodine or isopropyl alcohol
• Food allergies

Your provider will also give you specific instructions on eating and drinking before your radical nephrectomy. If you have food or fluids in your stomach during surgery, you have an increased risk of vomiting. If vomit enters your lungs, it can affect your breathing and cause damage.

They’ll verify which kidney they’ll remove (left radical nephrectomy or right radical nephrectomy). They’ll also discuss which type of radical nephrectomy is best for you.

What are the types of radical nephrectomy?

There are different types of radical nephrectomy:

• Open radical nephrectomy. During an open radical nephrectomy, the surgeon uses a sharp knife (scalpel) to carefully make a cut (incision). The incision may be as long as 12 inches (30 centimeters). The surgeon may recommend open surgery if you have a larger kidney tumor or if they need to remove all of the surrounding lymph nodes.
• Laparoscopic radical nephrectomy. During a laparoscopic radical nephrectomy, the surgeon uses a thin metal instrument with a camera at the end (laparoscope) to perform the surgery. Laparoscopic surgeries use several small incisions (less than an inch, typically 0.5 cm to 1 cm) instead of one large incision. Laparoscopic radical nephrectomy is more common than open nephrectomy.
• Robotic radical nephrectomy. During a robotic radical nephrectomy, the surgeon controls a surgical robot. The robot has arms that hold tiny instruments. The instruments enter your body through several small incisions instead of one large incision. A robotic approach has many of the same advantages as a laparoscopic approach.

What happens during a radical nephrectomy?

A special group of healthcare providers make up the care team during a radical nephrectomy, including:

• A urologist
• An anesthesiologist
• Nurses

The anesthesiologist will sedate you with general anesthesia. You’ll be asleep, won’t move and won’t feel any pain during the procedure. After you’re asleep, a nurse will insert a urinary catheter to drain any pee from your urinary bladder.

During an open radical nephrectomy, the urologist (surgeon) will:

• Use a scalpel to make an incision and examine the kidney and its surrounding area to make sure the cancer hasn’t spread
• Use clamps to block the blood vessels that transport blood into and out of the area
• Remove the kidney and some fatty tissue
• If necessary, they’ll remove any affected lymph nodes, the adrenal gland and part of your ureter (the ureter is a tube of muscle that carries pee from your kidneys to your urinary bladder)
• The surgeon may insert a surgical drain into the incision to help drain blood and other excess fluids as you heal
• Close the incisions with stitches and/or staples

During a laparoscopic or robotic radical nephrectomy, the urologist will:

• Use a scalpel to make three to five small incisions in your side
• Insert a laparoscope into an incision (the laparoscope projects video to a monitor above the operating table)
• Insert a small tube into an incision to your abdominal cavity with carbon dioxide gas (the gas separates your abdominal wall from your organs so it’s easier to see and move the surgical instruments)
• Clamp the blood vessels in the area
• Using the monitor as a guide, insert small surgical tools through into the incisions to remove your kidney, some fatty tissue and any other affected organs or tissue
• Release the gas from your abdomen
• Close the incisions with stitches and/or staples

How long does a radical nephrectomy take?

A radical nephrectomy can take three or more hours to complete.

What happens after a radical nephrectomy?

Immediately after a radical nephrectomy, your care team will:

• Cover your affected areas with a bandage
• Stop putting anesthesia into your body (you’ll wake up in a few minutes, but will probably still feel groggy)
• Send the kidney tumor to the pathology lab for testing
• Move you to a recovery room, where they’ll wait for you to wake up more fully and track your overall health
• Treat your pain and teach you pain management techniques

You’ll avoid solid foods for a day or two after surgery. Liquids will help give your body time to recover. As you heal, providers will reintroduce you to solid foods.

Usually a day after surgery, providers will encourage you to walk. Walking helps the healing process by promoting blood flow to the area. Walking can also help reduce the chance of other complications, including blood clots in your legs and pneumonia.

As early as the morning after surgery, a provider will remove the urinary catheter.

Once your care team determines you’re healthy, they’ll let you go home. You may still have pain or difficulty moving, so a family member or friend must drive you home. It’s a good idea to have a family member or friend take care of you for at least a few days after the procedure, too.

What are the benefits of a radical nephrectomy?

The main benefit of a radical nephrectomy is that it treats a condition that affects your kidney. Without a radical nephrectomy, some conditions that affect your kidney may be deadly. You can also donate a kidney to save a loved one’s life. Most people can function well with one kidney. It’ll get bigger and stronger, and you won’t notice a difference after surgery.

What are the risks or complications of a radical nephrectomy?

Like all surgeries, a radical nephrectomy has some risks, including:

• Infection
• Bleeding
• Post-operative pneumonia
• Blood clots
• Scarring
• Anesthesia complications

If your remaining kidney stops functioning properly or has a disease, it may also fail.

Can kidney cancer return after a radical nephrectomy?

Yes, kidney cancer can come back after a radical nephrectomy in another part of your body or near the original tumor.

What is the recovery time after a radical nephrectomy?

Your recovery depends on the type of radical nephrectomy you have. An open radical nephrectomy usually takes longer to heal than a laparoscopic radical nephrectomy. Most people can resume normal activities, including lifting and engaging in strenuous activities, eight to 12 weeks after a radical nephrectomy. Your healthcare provider will give you a better idea of your recovery timeline.

When can I go back to work or school?

You should be able to return to work or school in about four weeks. If you have a more physically demanding job, you may need more time off. But if you have a less physically demanding job, you may be able to return to work sooner.

What is the life expectancy after having a kidney removed?

Your life expectancy depends on your health history and any other conditions you have. If you have one healthy kidney, it can typically do everything your body needs it to do. You may need to eat more foods that promote kidney health, exercise and go in for regular check-ups.

If you have a radical nephrectomy in childhood, it’s possible that you’ll lose some function in your remaining kidney later — usually, at least 25 years later. However, this loss is usually mild and doesn’t affect your lifespan.

When should I call a healthcare provider?

Schedule regular follow-up appointments with your healthcare provider to examine your incision(s). If you have a drainage tube, they’ll usually remove that after a few days.

If you had a radical nephrectomy to remove kidney cancer, you’ll need regular tests to make sure the kidney cancer doesn’t come back (recur). Most people get CT scans or other imaging tests at regularly scheduled times. You may also need regular bloodwork, urine tests (urinalyses) and blood pressure checks.

If you have protein in your kidneys (proteinuria), there may be a problem with your remaining kidney. Every few years, you’ll need to test your kidney functions as well, including a creatinine clearance test and estimated glomerular filtration rate (eGFR).

Contact a provider right away if you have any of the following symptoms after a radical nephrectomy:

• Heavy bleeding at your incision sites
• Signs of infection, including discolored drainage or a bad odor coming from your incision sites or a fever over 100 degrees Fahrenheit (37.78 degrees Celsius) or higher
• Blood in your pee (hematuria)

What is the difference between a nephrectomy and a radical nephrectomy?

“Nephrectomy” is the general name for surgery to remove all or part of a kidney. A radical nephrectomy is a type of nephrectomy. The other type of nephrectomy is a partial nephrectomy. A partial nephrectomy only removes part of your kidney.

What stage of cancer requires a radical nephrectomy?

A healthcare provider may recommend a radical nephrectomy if you have stage II or stage III kidney cancer.

During stage II kidney cancer, the cancer has grown, but it hasn’t spread beyond your kidney. During stage III kidney cancer, the cancer has started to spread to other areas around your kidney.