• Surgical Procedures for Kidney Cancer

    Surgery is the initial procedure in the treatment of many cancers. Surgery and other invasive procedures work by removing cancerous tissues.
    Surgical removal of the kidney offers the best option for a cure for patients able to physically tolerate the procedure. Surgery also may be used to remove cancerous lesions that have spread to other organs. This is usually done to control symptoms and not to cure the disease.

    Nephrectomy

    Nephrectomy is the removal of the whole kidney. Doctors may be able to remove part of the affected kidney (partial nephrectomy) in certain cases, such as:
    • The tumor is small.
    • The cancer is in both kidneys.
    • You have only one functioning kidney.
    Nephrectomy is recommended for Stage I and II kidney cancer. Nephrectomy plus removal of regional lymph nodes is common for Stage III. If the cancer has spread to the renal vein, the doctor may remove the tumor and repair the vein.
    The doctor may recommend an arterial embolization prior to surgery to decrease blood flow to the affected kidney. For this procedure, a catheter is inserted through the groin and threaded up to the renal artery. The doctor injects a substance into the artery to block blood flow.
    Description of the Procedure
    The surgeon makes an incision under the ribs or in the back just behind the kidney. Then the surgeon removes the whole malignant kidney (radical nephrectomy) or a portion of the cancerous kidney (partial nephrectomy). He or she may also remove the adrenal gland; one adrenal gland sits above each kidney. Nearby lymph nodes may also be taken out. The incision is closed with stitches or staples, and bandaged to prevent infection.
    Generally, this has been an open procedure. But the laparoscopic approach has become the preferred method to treat kidney cancer if suitable. With this method, small incisions are made in the skin through which a camera, light source, and surgical instruments are inserted. The surgeon performs the surgery using these tools, without cutting open the abdomen or back. With the laparoscopic approach you should have a faster recovery and spend only a couple of days in the hospital. Open surgery is still performed, usually for larger tumors that require more extensive surgery. You will stay in the hospital for four to seven days.
    Effectiveness
    Nephrectomy is very successful. It has a five-year survival rate of 94% for patients with Stage I disease. For Stage II, it offers a five-year survival rate of 79%. The survival rate varies for Stage III, depending on where and how extensively the cancer has spread.
    Possible Complications
    • Bleeding
    • Infection
    • Damage to other internal organs or blood vessels during the procedure
    • Reaction to anesthesia
    • Collection of air or gases in the lung cavity (pneumothorax)
    • Kidney failure, if the remaining kidney does not function well
    Postoperative Care
    After surgery, you may need certain interventions:
    • Urinary catheter—A tube is passed through the urethra into the bladder to measure urine output and avoid the need to urinate in the bathroom.
    • Medications—You may be given antibiotics, pain medication, or antinausea drugs after surgery.
    • Coughing and deep breathing exercises—Your nurse or respiratory therapist will show you how to do these exercises, which are usually done 3-4 times daily to help keep your lungs clear.
    In the hospital and after you leave:
    • Get out of bed often and sit in a chair. Increase your activity as much as tolerated.
    • Stay well hydrated.
    • Avoid environments and people that expose you to germs, smoke, or chemical irritants.
    Call Your Doctor If Any of the Following Occurs
    • Difficulty breathing
    • Stitches or staples come apart
    • Bandage becomes soaked with blood
    • Coughing up mucus that is yellow, green, or bloody
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
    • Cough, shortness of breath, chest pain, or severe nausea or vomiting

    References

    American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp?level=0 .

    Bast R, Kufe D, Pollock R, et al, eds. Cancer Medicine. 5th ed. Hamilton, Ontario: BC Decker Inc; 2000.

    Kidney Cancer Association website. Available at: http://www.kidneycancerassociation.org/ .

    National Cancer Institute website. Available at: http://www.cancer.gov/ .

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