Nephrectomy, Radical (Kidney Removal)

What is a radical nephrectomy?

A radical nephrectomy is a procedure done to remove cancer in and around a kidney. The surgeon removes the kidney and the ureter connecting the kidney to the bladder. The surrounding connective tissue, lymph nodes, and adrenal gland are also removed.

When is it used?

This procedure is done to remove cancer in your kidney or ureter.

How do I prepare for this procedure?

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. Avoid medicines that may contain aspirin, such as nonprescription cold medicines. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions your healthcare provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general anesthetic. It will relax your muscles and cause a deep sleep. It will prevent you from feeling pain during the operation.

The surgeon makes a cut (incision) either in the front or on the side of your abdomen. Rarely, for some large tumors, the cut may extend into the lower part of the chest. The surgeon separates the kidney from the organs around it. Then the surgeon removes the kidney and the tumor. He or she ties off the ureter and main vein and artery that connected to the kidney. The surgeon also removes surrounding tissue and the adrenal gland and lymph nodes.

The surgeon may also make the cut longer or make a second cut over your bladder to remove the ureter. The surgeon will remove the ureter down to the bladder and close the cut.

An alternative to open nephrectomy is robotic laparoscopic nephrectomy. Robotic surgery is done in a similar way to open surgical removal of the kidney. The difference is that instead of a large cut in the front of the stomach, only 4 to 6 small cuts, each less than an inch long, are needed. Your surgeon’s tools can pass through these small cuts to do the surgery, keeping his or her hands outside your body. Your healthcare provider will explain the choices and help decide which procedure is best for you.

What happens after the procedure?

You may stay in the hospital for about 4 to 7 days. A catheter (tube) stays in your bladder for about a week to allow urine to drain and to relieve the pressure. Rarely, you may have a tube in your chest for 1 to 4 days if part of your incision is in the chest.

During the first 2 weeks after the operation, you will be encouraged to do light activity, such as walking. Avoid all heavy activity for the first 6 weeks, including lifting. After that time, you may gradually do heavier work according to your healthcare provider's instructions.

Ask your healthcare provider about what medicines you can take for pain and how to care for yourself during your recovery. Removing a kidney may reduce your kidney function enough to cause problems when you take medicines. Ask your provider for a list of medicines that you should avoid. Medicines that contain acetaminophen or nonsteroidal anti-inflammatory drugs (such as ibuprofen) may be ones that you need to avoid.

Ask when you should come back for a checkup.

What are the benefits of this procedure?

The cancer may be cured. Even when cure is not possible, you will be more comfortable. You will avoid the problems of a growing tumor in the kidney, such as severe bleeding.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• The spleen or pancreas may be injured during the operation.
• The nerves in the area of the incision may be damaged either by pressure or by being cut. This could cause problems with the muscles in your lower back. It could also cause the side of your abdomen to sag. You could lose the feeling in the area around the incision. This could be a temporary or permanent condition.
• Urine may leak from the cut made in the bladder.
• The surgeon may not be able to remove all of the cancer or the cancer may come back.
• Your kidney function will be tested before surgery. If your remaining kidney is weak, your healthcare provider will discuss this special risk with you before surgery. You may need dialysis. Dialysis is a mechanical way to do the work your kidneys normally do.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a fever over 100°F (37.8°C).
• You become nauseated or start vomiting.
• You have a lot of pain.
• You become unusually weak.
• The wound is leaking or bleeding.
• You become short of breath.
• You have trouble passing urine.

Call during office hours if:

• You have questions about the procedure or its result.
• You begin to have swelling in your legs and ankles.
• You want to make another appointment.