What is an open partial nephrectomy?
An open partial nephrectomy is a surgery in which kidney cancer is removed along with a rim of normal kidney tissue next to it. After the cancer and the rim of normal kidney tissue are removed, the kidney is reconstructed. The goal is to save as much kidney function as possible. This is important because the kidneys are the main filters of the body and they are essential for life. After the tumor and normal tissue are removed from the kidney, they are sent to a laboratory to be tested.
What are the reasons why someone would need an open partial nephrectomy?
The procedure may be required for several reasons, including:
- Damage from kidney stones
- Injury from trauma
- Congenital abnormalities
- High blood pressure caused by blood supply problems to the kidneys
What happens during an open partial nephrectomy?
During the surgery, the blood vessels going into and out of the kidney are temporarily clamped and the kidney is cooled with ice to save as much kidney function as possible. The clamps are removed after the kidney is reconstructed. The kidney will then turn pink again, usually with no bleeding from the reconstructed part of the kidney.
Risks / Benefits
What is the advantage of an open partial nephrectomy in general, and versus a nephrectomy?
After an open partial nephrectomy, the patient is able to live with almost two full kidneys. This is preferred over a radical (total) nephrectomy, in which a kidney is removed. Open partial nephrectomy has the lowest rate of serious complications, such as postoperative bleeding or inadvertent loss of the kidney, and it allows the surgeon to do the most difficult of cases in as safe of a manner as possible.
Most patients with one kidney or those that have suboptimal kidney function are typically best managed with open partial nephrectomy to save as much kidney function as possible. Tumors in the central portion of the kidney, where the vessels are going into and out of the kidney, are typically managed with the open approach.
What are some of the complications and risks of having an open partial nephrectomy?
As with any surgery, there can be complications and risks related to open partial nephrectomy. These may include:
- Bleeding that may require a blood transfusion
- Urinary leakage which almost always resolved with delayed healing
- Allergic reaction to anesthesia (rare)
- Kidney failure, depending on the functioning of the remaining partial and whole kidney
- Pneumonia following surgery
- Blood clots in the legs that may travel to the lungs
Recovery and Outlook
What follow-up care do I need after an open partial nephrectomy?
After surgery, your doctor may want to test and monitor the following things:
- Blood pressure: You will need to carefully monitor your blood pressure, as decreased kidney function can lead to increased blood pressure. Increased blood pressure can also damage a kidney.
- Protein urine levels: High protein levels in the urine could indicate poor kidney function or kidney damage. This is a very uncommon but important consideration after any kidney surgery.
- Glomerular filtration: This is a measure of how efficiently your kidney is filtering waste. A blood sample can be used for the test. Reduced glomerular filtration indicates decreased kidney function.
In order for you to preserve normal kidney function, your doctor may recommend that you eat a healthy diet, engage in daily physical activity, and have regular checkups to monitor your kidney health. If you develop kidney disease in the remaining kidney after nephrectomy or partial nephrectomy, your doctor may recommend changes to your diet, such as limiting protein or salt.
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