Surgery for Kidney Cancer (Renal Cell Cancer)

This content has been reviewed and approved by

Robert J. Motzer, MD
Attending Physician

Memorial Sloan-Kettering Cancer Center

Your doctor will always recommend surgery to treat your kidney cancer unless you are too sick to tolerate the procedure. Currently, most physicians think that it's important to remove the primary cancer even when you have widespread cancer at diagnosis.

In patients with stage I or II kidney cancer, surgery alone cures most patients. For patients with stage III kidney cancer, surgery may cure the cancer, depending on the extent of disease. Surgically removing some metastatic (spreading) cancers can also offer a cure.

Surgery can also play a major role in relieving cancer symptoms in patients with stage III and IV kidney cancer and in those with recurrent disease (when the cancer comes back). There also is the general belief that immunotherapy (treatments that boost your own body's disease-fighting system) will work better if as little cancer as possible is left in your body before you begin treatment.

Surgical Approaches and Techniques

There are several surgical approaches that doctors may use, depending on the extent of your disease and overall condition.

Radical Nephrectomy

The gold standard for treating renal cell cancer is radical nephrectomy. Radical nephrectomy is the surgical removal of the whole kidney tissue around the kidney and lymph nodes in the area. Removal of the adrenal gland may also be performed, although many surgeons today avoid this when possible.

Often, doctors remove the lymph nodes around the kidney as part of a radical nephrectomy. The purpose is to examine the lymph nodes under the microscope to see if they contain cancer. If the lymph nodes contain cancer, the stage of the cancer changes and affects treatment and outcome.

Partial Nephrectomy

Your doctor may suggest partial nephrectomy to preserve as much of your normal kidney tissue as possible. A partial nephrectomy is a procedure that involves removing only the part of the kidney with cancer and the edge of normal kidney tissue surrounding the cancer.

When your doctor cannot remove your tumor safely by partial nephrectomy, a radical nephrectomy is necessary. When you choose to have a partial nephrectomy, there is always a chance that your doctor will have to remove your entire kidney.

Currently, patients with stage III renal cell cancer should discuss the risks and benefits of partial nephrectomy with their treating physician. If your doctor suggests partial nephrectomy, you should request information about long-term results from the treating surgeon.

Laparoscopic Nephrectomy

Laparoscopic radical nephrectomy is a new type of surgery that is now performed more often due to its benefits in faster and less painful recovery from surgery. Laparoscopic nephrectomy is less invasive than an open nephrectomy, which is performed with traditional, larger incisions (surgical cuts).

During a laparoscopic nephrectomy, the surgeon makes small, "keyhole" incisions in the abdomen and side. The surgeon then inserts a very small tube (laparoscope) that holds a video camera into the incisions to create a live picture of the area inside your body. This picture allows the surgeon to remove the kidney through the smallest possible incision, using long, thin instruments.

Compared with open radical nephrectomy, there is less postoperative pain, shorter hospital stays, and shorter recovery time. If you choose to undergo a laparoscopic radical nephrectomy, there's a small risk (usually less than 5 percent) that your surgeon will need to convert the surgery to an open nephrectomy (that is, convert the "keyhole" incisions to a larger incision).

Not all patients are candidates for laparoscopic nephrectomy. Laparoscopic radical nephrectomy is most effective in patients with small, localized tumors with no cancer spread into the lymph nodes or renal vein. Doctors prefer open nephrectomy in patients with severe scarring around the kidney or a history of extensive abdominal surgery.

Risks of Surgery

The risks of surgery include bleeding, which may require blood transfusions, wound infection, damage to internal organs and blood vessels (such as spleen, pancreas, aorta, vena cava, and large and small bowel) during surgery, pneumothorax (unwanted air in the chest cavity), incisional hernia (bulging of internal organs underneath the surgical incision), and kidney failure (if the remaining kidney doesn't work well).

Some patients cannot tolerate surgery because of poor health (heart or lung problems, for example) and their doctor may have to use alternative treatments. Patients should make sure that they understand the risks associated with surgery in their specific situation.

Your Kidney Function

When kidney tissue is removed (by nephrectomy) or destroyed (by ablation or embolization), the remaining functional kidney tissue usually works well enough to prevent problems. Nonetheless, your doctor needs to assess your kidney function periodically after treatment.

In a patient who undergoes a radical or partial nephrectomy on one side and has a normal kidney on the other side, the need for dialysis is extremely rare. In fact, people can live a normal life with only one functioning kidney. When a patient has only one kidney (a "solitary" kidney), and part of that kidney needs surgery, there is a risk of problems with kidney function. If severe, these problems could lead to temporary or permanent dependence on dialysis.

In most cases, problems with kidney function are temporary and improve without treatment. When the remaining functional renal tissue is less than one entire kidney, there is a risk that the function of that tissue will deteriorate (decrease) over time. This deterioration is called hyperfiltration injury and may occur up to 10 years after surgery.

In some cases, your doctor may be able to prevent hyperfiltration through surveillance or careful monitoring, including:

• Blood pressure monitoring
• Serum creatinine
• Urinary protein
• 24-hour urine assessment for protein, creatinine, and glomerular filtration rate

Alternative Approaches to Tumor Spread

When a tumor spreads into the renal vein (major vein of the kidney) or vena cava (vein leading from the renal vein to the heart), doctors recommend open surgery to remove the affected kidney and to remove the tumor from the vein(s). It is important that you find a urologist who has experience with this type of surgery. If you cannot tolerate surgery, your doctor may consider surveillance and embolization.