Surgery for kidney cancer
Most people with kidney cancer will have surgery. The type of surgery you have depends mainly on the size of the tumour and stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your age and overall health, if one or both of your kidneys are working and how well your kidneys are working.
Surgery may be done for different reasons. You may have surgery to:
- completely remove the tumour
- remove as much of the tumour as possible (called debulking) before other treatments
- relieve pain or ease symptoms (called palliative surgery)
Before you are offered surgery, the healthcare team will carefully check your kidneys to see how well they are working. They may use glomerular filtration rate (GFR) blood test and MAG3 imaging test to check your kidneys. Knowing how well your kidneys are working will help your healthcare team decide if you are at risk for developing chronic kidney disease or if you will need dialysis after surgery. Find out more about supportive care for kidney cancer, including dialysis.
Smoking cigarettes can affect the health of your kidneys. It is often suggested that smokers quit before they have surgery. The healthcare team will also check if you have high blood pressure, diabetes and heart disease because these can also damage your kidneys.
The following are the types of surgery most commonly used to treat kidney cancer. The surgeon will try to remove the kidney tumour, or as much of the tumour as possible, while making sure that the rest of the kidney with cancer and the other kidney still work properly. You may also have other treatments before or after surgery.
|Surgeries for kidney cancer|
Most people with kidney cancer will have a nephrectomy, which is surgery to remove part or all of the kidney. Different types of nephrectomy are done depending on the size and location of the tumour.
The surgeon can use an open or laparoscopic approach to nephrectomy. Where the surgeon makes the cut depends on the size and location of the tumour. It may be in the side, back or abdomen.
For open surgery, the surgeon makes a large incision, or surgical cut, to reach the kidney.
For laparoscopic surgery, the surgeon makes small cuts and inserts an endoscope (a thin, tube-like instrument with a light and lens). The surgeon uses the endoscope and other tools to examine the kidney and surrounding area, as well as remove the kidney.
The advantages of laparoscopic surgery include shorter surgery time, less bleeding during surgery, less pain and a shorter hospital stay. Surgeons need special training and equipment to do laparoscopic surgery.
Partial nephrectomy removes the kidney tumour along with some healthy tissue around it. This surgery leaves the rest of the kidney in place. Partial nephrectomy is sometimes called nephron-sparing, or kidney-sparing, surgery.
Doctors are using partial nephrectomy more often now than in the past, even with large tumours. This surgery can effectively treat kidney cancer so it doesn’t come back, or recur. It also lowers the chance of getting some of the side effects that can develop after other types of nephrectomy, such as chronic kidney disease or heart problems.
Keeping as much of the kidney and making sure it works as normally as possible are especially important if you have a higher risk of developing kidney problems after surgery. You may have a higher risk for kidney problems if you have diabetes, high blood pressure, genetic types of kidney cancer or kidney disease. Some chemotherapy drugs can also damage the kidneys.
The surgeon can use an open or laparoscopic approach to do a partial nephrectomy. Laparoscopic partial nephrectomy is used for people who have a higher risk of developing kidney problems after surgery.
In very rare cases, the surgeon may do an extracorporeal partial nephrectomy. This surgery is used if the person only has one kidney and the tumour is in the middle of it. During this type of surgery, the kidney is taken out of the body. The surgeon uses a special microscope to see and remove the tumour, saving as much normal kidney tissue as possible. The surgeon then places the kidney back into the body. An extracorporeal partial nephrectomy is a very specialized surgery and may not be available in all treatment centres.
Radical nephrectomy removes the whole kidney, the ureter attached to the kidney and the layer of fat around the kidney. The adrenal gland is removed if it is larger than normal size and there are signs that the kidney tumour has spread into it. Lymph nodes are usually only removed if imaging tests show that the cancer has spread to them.
Radical nephrectomy isn’t used as often as it was in the past because there is a higher risk of developing chronic kidney damage and cardiovascular disease after this surgery.
The surgeon can use an open or laparoscopic approach to do a radical nephrectomy. Most people will have laparoscopic radical nephrectomy. Open surgery is used for tumours that can’t be removed with a laparoscopic surgery. This includes tumours that are very large or bulky, that have grown into the renal vein or that have grown far into the vena cava. An open approach is also used if the tumour has spread outside the kidney or if the surgeon needs to control bleeding from the kidney.
Simple nephrectomy removes the kidney and the attached ureter, but not the adrenal gland or lymph nodes around the kidney. It is most often used for non-cancerous tumours. It can also be used to remove small, early stage cancerous tumours.
The surgeon can use an open or laparoscopic approach to do a simple nephrectomy, but laparoscopic surgery is done more often.
Cytoreductive nephrectomy includes radical nephrectomy and surgery to remove as much of the cancer as possible. It is used when kidney cancer has spread outside the kidney to lymph nodes and other organs, such as the liver or lungs.
Cytoreductive nephrectomy is offered to people with metastatic kidney cancer because this surgery helps make targeted therapy more effective. It is most often offered to people with clear cell renal cell carcinoma (RCC), but it may also be offered to people with other types of kidney tumours. It is not offered to people who have kidney cancer that has spread to the brain (called brain metastasis) because it doesn’t make treatment for brain metastasis more effective.
The surgeon can use an open or laparoscopic approach to do cytoreductive nephrectomy. The advantage of laparoscopic surgery is that the person heals quicker, which means targeted therapy can be started sooner.
Lymph node dissection (also called lymphadenectomy) is surgery to remove lymph nodes around a tumour. Researchers are still studying lymph node dissection to find out if it helps treat kidney cancer, especially if tests don’t show that the cancer has spread to the lymph nodes.
Studies have shown that the following criteria may help doctors decide to remove lymph nodes in people with kidney cancer:
- the tumour is stage T3 or T4
- the tumour is grade 3 or 4
- the tumour is 10 cm or larger
- there are areas of dead cells (called necrosis) in the tumour
- the tumour is a renal sarcoma or the cancer cells have sarcomatoid features
People who have only 1 of these criteria have a low risk that the cancer has spread to the lymph nodes. People who have all of these criteria have the greatest chance that cancer is in the lymph nodes. If the person is at high risk, the surgeon may remove lymph nodes during surgery to remove the kidney tumour.
Cancer that has spread to other parts of the body is called metastasis. Surgery may be used to help relieve pain and other symptoms from kidney cancer metastasis. This is called palliative surgery. If all the cancer can be removed, palliative surgery may successfully treat the cancer or lengthen remission.
Palliative surgery may be done if there is only one metastatic tumour. It may also be offered if there are several tumours that can easily and safely be removed with surgery.
A drain is a small, usually plastic, tube. It may be placed in the incision made to remove the tumour. This tube will drain fluids and urine from the area around your kidney. It is normal to see a small amount of blood in the fluids that drain through the tube. You may have to go home with the drain in place if there is still fluid draining through the tube. Your doctor will remove the tube when the fluid stops draining.
During surgery, the surgeon will place a urinary catheter to drain your bladder after surgery. It is normal to have some blood in the urine for a few days after surgery.
A stent is a thin plastic tube. Your surgeon may place a stent between the kidney and the bladder to help the urine drain from the kidney. This stent may be left in place for some time after surgery. Your surgeon will remove it when your kidney has healed.
Certain inherited genetic conditions, including von Hippel-Lindau syndrome and hereditary papillary renal carcinoma (HPRC), give you a higher risk of developing kidney cancer. People with these conditions are more likely to develop certain types of tumours and often develop tumours in both kidneys over time. The surgeon will consider these factors when deciding the type of surgery to offer.
Most people with a genetic condition that can cause kidney cancer will be followed with active surveillance if they have tumours smaller than 3 cm. Using active surveillance means that surgery can be postponed as long as possible. If you have a tumour larger than 3 cm, the surgeon will use partial nephrectomy to remove it.
People with hereditary leiomyomatosis renal cell carcinoma (HLRCC) have a high risk of developing very aggressive kidney tumours that can spread quickly and at an early stage. If you have HLRCC, your surgeon will use partial nephrectomy to remove it, if possible.
Side effects can happen with any type of treatment for kidney cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Side effects can develop any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.
Side effects of surgery will depend mainly on the type of surgery and your overall health. Surgery for kidney cancer may cause these side effects:
- kidney problems or kidney failure
- leaking of urine from the renal pelvis into the abdomen
- a weak spot in the muscles of the abdomen where the large intestine sticks out (called a hernia)
Tell your healthcare team if you have these side effects or others you think might be from your surgery. The sooner they are aware of any problems, the sooner they can suggest ways to help you deal with them.
Questions to ask about surgery
The tube that carries urine from the kidney to the bladder.
A small gland on top of each kidney that produces a variety of hormones involved in different body functions, including metabolism (the chemical processes needed for cell function, growth and reproduction), heart rate, blood pressure and controlling blood sugar levels.
A decrease in or the disappearance of signs and symptoms of a disease (such as cancer).
Complete remission means the disappearance of all signs or symptoms. Partial remission means a decrease in or disappearance of some, but not all, signs and symptoms. Spontaneous remission is an unexpected improvement that occurs with little or no treatment.
A flexible tube used to carry fluids into or out of the body.
For example, an intravenous catheter delivers fluid into the body through a vein and a urinary catheter carries urine from the bladder out of the body.