Overview
Radical nephrectomy is the complete removal of a kidney and some additional structures in case of various kidney tumours.
When is Kidney Removal Surgery Needed?
The most common reason why a radical nephrectomy is performed is to remove cancer infiltrated kidneys. However, there could be another kidney disease that can cause damage to this organ.
Diagnosis of Kidney Cancer
Diagnosis of kidney cancer requires a thorough medical history and a physical examination. Doctors will examine the abdomen for any signs of swelling or a lump. In men, doctors may look for an enlarged, twisted vein, or varicocele treatment, in the scrotum.
Diagnostic tests to diagnose kidney cancer are:
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Urinalysis: A urinalysis will show signs of blood, cancer cells, and other abnormalities in the patient’s urine sample.
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Complete blood count (CBC): A complete blood count can tell whether the red blood cell count is high, showing polycythaemia. Polycythaemia occurs when the body produces too many red blood cells, causing the blood to thicken and may lead to various issues. Because the kidney produces erythropoietin (a hormone that encourages the formation of RBCs), an increase in RBCs could show a kidney tumour.
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Blood chemistry tests: Blood chemistry tests can help determine how well the kidneys are functioning. Kidney cancer can impact amounts of certain molecules in the blood, such as liver enzymes and calcium.
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Ultrasound of the abdomen and kidneys: An abdomen ultrasound can determine the size and form of kidney cancer. Because an ultrasound may miss tiny tumours or kidney stones, another imaging test may be required.
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Renal CT Angiography: This allows doctors to examine the blood supply to the kidneys in greater detail. The blood supply to a tumour can be visible if one is present.
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CT scan of the abdomen: A CT scan allows for examination of bones, muscles, fat, organs, and blood vessels. It will help doctors assess the spread of cancer.
Tests to find out if kidney cancer has spread:
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Bone scan
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PET scan
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Chest CT scan
After all the tests, if the surgeon thinks the best approach is removing the entire kidney, then they will recommend radical nephrectomy. Doctors may decide on a partial or radical nephrectomy based on:
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Whether the cancer is confined to the kidney
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Number of tumours
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The portion of the kidney affected
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Is cancer infiltrating the nearby tissues?
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How well the other kidney is functioning?
Treatment of Kidney Cancer
Radical nephrectomies can be “open”, “laparoscopic”, or “robotic”.
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Open radical nephrectomy: A single incision or opening is made on the abdomen. This method enables surgeons to do some surgeries that are impossible to execute safely with less invasive techniques. Nowadays, it is only reserved for the large tumour in the treatment of the adjacent structure, venous thrombosis.
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Laparoscopic Radical Nephrectomy: This procedure is performed through a series of tiny incisions. The surgeon uses a laparoscope to move around the body. It has a tiny camera. When the surgeon is ready to remove the kidney, that tiny incision is expanded.
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Robotic Radical Nephrectomy/Robotic Partial Nephrectomy
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Lymph node removal: If the lymph nodes are enlarged, they may be compromised. If enlarged lymph nodes are detected during surgery, the urologist will decide to remove them.
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Adrenal Gland Removal: Adrenal gland is crucial for survival. It produces stress hormones. If the tumour has infiltrated the adrenal gland, it will be removed via adrenalectomy. A CT scan can confirm if the tumour has spread to the adrenal gland or not.
Who Are the Best Candidates for Kidney Removal Surgery?
The goal of any treatment or surgery is to remove only the damaged part of the body and leave the rest. The same is true for Radical Nephrectomy. However, partial nephrectomy is not always a viable option.
A patient is suitable for a radical nephrectomy if:
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The kidney is severely damaged and cannot function at all.
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The other kidney is in optimal condition.
Nowadays, with the concept of Nephron Sparing Surgery, Partial Nephrectomy is preferred wherever possible.
Older patients between the age of 70 and 80 years are advised to undergo radical nephrectomy because the risk of blood loss during a partial nephrectomy is far greater than the benefit of saving a part of the kidney. But indication varies from person to person.
Who Should Not Consider for Kidney Removal Surgery?
A person should avoid radical nephrectomy if:
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There is only one healthy kidney; partial nephrectomy is preferred.
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A patient Suffers from bleeding disorders such as haemophilia.
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They suffer from decompensated heart failure or diabetes mellitus(uncontrolled).
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They are on anti-coagulation medicines.
How to Prepare for Kidney Removal Surgery?
Before scheduling the surgery, patients should clear all doubts with their surgeon. One should ask questions like:
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Will I need a radical or partial nephrectomy?
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Am I a candidate for a laparoscopic procedure?
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Am I a candidate for a robotic procedure?
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Are there any other treatment options available?
Plan for a Hospital Stay
Patients who have undergone a Radical Prostatectomy usually stay on for three to four days under observation in recovery. This is done to make sure the patient is stable.
Pre-Operative Test for Kidney Removal Surgery
Doctors may perform some pre-operative tests to make sure the patient can undergo the procedure with no complications.
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Patient is cleared for surgery from different departments, such as cardio, neuro, pulmonary, etc.
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Doctors should know about every medication and health supplement taken by the patient. This is crucial if they are on blood-thinning medication and pain relievers such as warfarin and aspirin, respectively.
Potential Complications of Radical Nephrectomy
Like with any surgery, radical nephrectomy entails the possibility of complications, such as:
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Bleeding
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Infection
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Injury to nearby organs
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Rarely, other serious problems
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Post-operative pneumonia
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Post-operative wounds
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Infection transmitted via the donated kidney
Long-term effects of a nephrectomy are related to the potential difficulties of living with fewer than two complete, fully functional kidneys. Long-term renal function problems can lead to the following complications:
But with due precautions and regular follow up, one can live a healthy life with a single kidney.
Taking Care After Kidney Removal Surgery
Doctors will inform how soon the patient can leave the hospital depending upon how the surgery went, if any complications arose, and their overall health.
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The patient will have a urinary catheter in place for a short time during recovery.
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The patient will receive instructions before leaving the hospital. For example, what to eat, surgical wound care, and signs of infection to look out for.
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They may be encouraged to resume light activities as soon as they feel ready but must avoid severe exertion or heavy lifting for many weeks.
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It may take up to six weeks to recover, including the ability to lift and engage in demanding activities.
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If the patient takes part in a contact sport, they should talk to the doctor about it because it is critical to safeguard the remaining kidney.
Last Update
Reviewed by Dr. Waheed Zaman, Director - Urology & Renal Transplantation, Urology, Kidney Transplant on 20-May-2022
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FAQs
What is a nephrectomy?
A nephrectomy is a surgical procedure that involves the removal of a kidney. It is commonly performed to treat conditions such as kidney cancer, kidney stones, kidney infections, and other kidney diseases.
Why is a nephrectomy performed?
A nephrectomy is performed to address various medical conditions, including kidney cancer, severe kidney damage or dysfunction, kidney infections that do not respond to other treatments, and the presence of large kidney stones causing significant pain or obstruction.
What are the different types of nephrectomy?
The different types of nephrectomy include open nephrectomy, laparoscopic nephrectomy, and robotic-assisted nephrectomy. The approaches vary in terms of the surgical technique used and the size of the incisions made.
How is an open nephrectomy performed?
In an open nephrectomy, an incision is made in the abdomen or side to access and remove the kidney. This traditional surgical approach allows direct visualization of the kidney and surrounding structures.
What is a laparoscopic nephrectomy?
Laparoscopic nephrectomy is a minimally invasive procedure where several small incisions are made, and a laparoscope with surgical instruments is inserted to perform the surgery. This technique offers quicker recovery and reduced scarring compared to open nephrectomy.
What is a robotic-assisted nephrectomy?
Robotic-assisted nephrectomy is a type of laparoscopic nephrectomy where the surgeon uses robotic arms to perform the surgery. The robotic system provides enhanced precision, dexterity, and visualization, allowing for complex procedures with smaller incisions.
Can a nephrectomy be performed for kidney cancer?
Yes, nephrectomy is a common treatment for kidney cancer, particularly when the cancer is localized to the kidney. It may involve removing either a portion of the kidney (partial nephrectomy) or the entire kidney (radical nephrectomy), depending on the extent of the cancer.
Is a nephrectomy the only treatment option for kidney cancer?
While nephrectomy is a primary treatment for kidney cancer, other treatment options may be considered depending on the specific characteristics of the cancer, such as targeted therapy, immunotherapy, radiation therapy, or ablation techniques.
Can a nephrectomy be performed for non-cancerous conditions?
Yes, a nephrectomy can be performed for non-cancerous conditions such as severe kidney infections, chronic kidney disease, polycystic kidney disease, and other structural abnormalities or dysfunctions that significantly impact kidney function and overall health.
What is a partial nephrectomy?
A partial nephrectomy is a procedure where only the diseased or affected portion of the kidney is removed while preserving the healthy portion. It is often performed for small kidney tumours or when preserving kidney function is a priority.
When is a partial nephrectomy preferred over a complete nephrectomy?
A partial nephrectomy is preferred over a complete nephrectomy when the tumour is small, the patient has only one functional kidney, or preserving kidney function is essential, such as in patients with pre-existing kidney disease or compromised kidney function.
What are the risks and complications associated with nephrectomy?
Like any surgical procedure, nephrectomy carries potential risks and complications, including bleeding, infection, blood clots, injury to surrounding organs or structures, adverse reactions to anaesthesia, and, in rare cases, complications related to removal of the kidney, such as urine leakage or urinary tract obstruction.
How long does a nephrectomy surgery typically take?
The duration of a nephrectomy surgery depends on various factors, including the complexity of the case, the surgical approach used, and the patient's overall health. On average, the procedure may take approximately two to four hours.
How long is the hospital stay after a nephrectomy?
The length of the hospital stay following a nephrectomy can vary depending on the patient's condition and the type of nephrectomy performed. Generally, patients can expect a hospital stay of two to five days, although laparoscopic and robotic-assisted procedures often involve shorter stays.
What is the recovery time after a nephrectomy?
The recovery time after a nephrectomy varies among individuals and depends on factors such as the type of surgery, the patient's overall health, and any complications encountered. Generally, it may take several weeks to a few months to fully recover and resume normal activities.
What is the expected pain level after a nephrectomy?
Postoperative pain levels can vary, but medications are typically prescribed to manage pain and ensure patient comfort during the recovery period. The medical team will provide guidance on pain management techniques and medications.
Will I need to modify my diet after a nephrectomy?
In most cases, dietary modifications are not necessary after a nephrectomy. However, maintain a healthy and balanced diet to support overall health and kidney function. The healthcare team may provide specific recommendations based on individual needs.
Can a nephrectomy affect kidney function?
Yes, a nephrectomy involves the removal of a kidney, which can impact overall kidney function. However, if the remaining kidney is healthy and functioning well, it can compensate for the loss, and most people can lead a normal, healthy life with one kidney.
Are there any long-term consequences of living with one kidney?
In general, living with one kidney does not lead to significant long-term consequences. However, it is important for individuals with a single kidney to maintain a healthy lifestyle, manage blood pressure and diabetes if present, stay hydrated, and attend regular follow-up appointments to monitor kidney function.
Can a nephrectomy be performed on patients with kidney stones?
Nephrectomy is generally not the first-line treatment for kidney stones. It is typically reserved for cases where the kidney stone is exceptionally large, causing significant obstruction, recurrent infections, or complications that cannot be effectively managed through less invasive procedures.
Can a nephrectomy be performed on patients with polycystic kidney disease?
Nephrectomy may be considered for patients with polycystic kidney disease in certain situations, such as when the cysts are causing severe pain, recurrent infections, bleeding, or when there is a risk of kidney rupture or the need for transplantation.
Can a nephrectomy be performed on patients with kidney infections?
In cases of severe kidney infections that do not respond to other treatments or when an abscess forms, a nephrectomy may be considered as a last resort. However, antibiotics and other conservative treatments are usually the first line of management for kidney infections.
Can a nephrectomy be performed on patients with kidney trauma?
Nephrectomy is occasionally performed for patients with severe kidney trauma that results in significant damage and poses a risk to the patient's health. However, efforts are made to preserve as much kidney function as possible, and partial nephrectomy may be considered if feasible.
Are there age restrictions for a nephrectomy?
There are no specific age restrictions for a nephrectomy. The decision to perform a nephrectomy is based on factors including the patient's overall health, the specific condition requiring treatment, and an assessment of the potential benefits and risks. Age alone does not preclude someone from undergoing a nephrectomy.
Can a nephrectomy be performed on pregnant women?
Nephrectomy is generally not recommended during pregnancy unless it is a life-threatening situation for the mother or the fetus. The risks and benefits must be carefully evaluated, and the procedure is typically performed only if there are no other viable options and the potential benefits outweigh the risks.
Can a nephrectomy be performed on patients with kidney failure?
In cases of kidney failure, a nephrectomy may be considered as part of the treatment plan. It can help alleviate symptoms, remove a diseased kidney, or create space for a potential kidney transplant. However, the decision depends on the specific circumstances and is made in consultation with a healthcare team.
Can a nephrectomy be performed on patients with congenital kidney abnormalities?
Nephrectomy may be considered for patients with certain congenital kidney abnormalities, such as severely malformed or non-functioning kidneys, or in cases where the abnormality poses a significant risk to the patient's health. However, each case is assessed individually, and alternatives are explored when appropriate.
Can a nephrectomy be performed on patients with renal cell carcinoma?
Nephrectomy is a common treatment for renal cell carcinoma, which is the most common type of kidney cancer. The extent of the nephrectomy depends on factors such as the size and location of the tumor, the stage of the cancer, and the patient's overall health.
Can a nephrectomy be performed on patients with Wilms tumor?
Nephrectomy is a primary treatment for Wilms tumor, a type of kidney cancer that primarily affects children. It involves the surgical removal of the affected kidney, and in some cases, additional treatments such as chemotherapy or radiation therapy may be recommended.
Can a nephrectomy be performed on patients with renal artery stenosis?
Nephrectomy is generally not the first-line treatment for renal artery stenosis. However, in cases where the stenosis is severe and causes uncontrolled hypertension or kidney dysfunction despite medical management, a nephrectomy may be considered as a last resort.
Can a nephrectomy be performed on patients with kidney metastasis?
Nephrectomy may be considered for select patients with kidney metastasis, depending on factors such as the primary cancer site, the extent of metastasis, and the overall health of the patient. It is often combined with other treatments, such as chemotherapy or targeted therapy, to manage the metastatic disease.
Can a nephrectomy be performed on patients with hypertension?
Nephrectomy is not a primary treatment for hypertension. However, in rare cases of severe hypertension caused by specific renal conditions, such as renal artery stenosis, a nephrectomy may be considered as a last resort when other treatment options have failed.
Can a nephrectomy be performed on patients with chronic kidney disease?
Nephrectomy is generally not recommended for patients with chronic kidney disease unless there is a specific indication, such as a diseased kidney causing recurrent infections or other complications that cannot be managed through conservative treatments. Preservation of kidney function is usually prioritized in patients with chronic kidney disease.
Can a nephrectomy be performed on patients with autoimmune kidney diseases?
Nephrectomy is not a common treatment for autoimmune kidney diseases. The management of these conditions typically involves medical therapies aimed at suppressing the immune system and preserving kidney function. Nephrectomy may be considered only in exceptional cases where other treatments have failed and the affected kidney poses a significant risk to the patient's health.
FAQs reviewed by Dr. Amit Kumar Gupta, Associate Director - Nephrology
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