Surgery for kidney cancer

This operation is called a partial nephrectomy or nephron-sparing surgery. It is the most common operation for kidney cancers smaller than 4cm. You may also have it for larger kidney cancers. Your doctor will explain if it is right for you.

During the operation, the surgeon removes the part of the kidney with the cancer. The aim is to remove the cancer but to leave as much normal tissue as possible. This is so the kidney can keep working.

You may have this operation to try and keep the affected kidney. This may be because:

• your other kidney does not work well
• you have kidney disease or other conditions that may affect how your kidneys work in the future.

If you have a type of kidney cancer that has been passed to you from a parent (inherited), you may be offered this operation. This is because there is a risk you may develop a cancer in the other kidney.

You are likely to be referred to a specialist hospital for this type of surgery. This means you may have to travel for treatment.

Your doctors may talk to you about an operation to remove the kidney even if the cancer has spread. It will not cure the cancer, but in some people, it may help them live longer. Your treatment plan will usually include other treatments such as immunotherapy and targeted therapy.

You may need to think about the possible advantages of having the kidney removed, as well as the effects of having a big operation. Your doctors will talk to you about the possible benefits and disadvantages.

There are different ways a surgeon can operate on the kidney. Your surgeon will explain how they will do your operation and answer any questions you have. You usually have a general anaesthetic for kidney cancer surgery.

Kidney cancer surgery is often done as keyhole surgery, but open surgery is sometimes needed.

During keyhole surgery, the surgeon uses a laparoscope to see and work inside the tummy (abdomen). A laparoscope is a thin tube with a light and camera on the end. It sends video images to a monitor.

The surgeon starts by making 3 or 4 small cuts in the tummy. The laparoscope then goes through 1 of the small cuts in the skin. The tummy will be inflated with gas to help the surgeon operate more easily.

During the operation, the surgeon puts the kidney they want to remove into a bag inside the body. At the end of the operation, they will remove the bag with the kidney inside by either:

• making 1 of the cuts bigger
• adding an extra cut.

The position of the cuts depends on who is having the surgery and how the surgeon does the operation. Your surgeon can talk to you about what to expect. Recovery from keyhole surgery is usually quicker than from open surgery. This is because the wounds are smaller.

Robot-assisted keyhole surgery

The surgeon may use a specialised machine to help with keyhole surgery. The surgeon controls the instruments that are attached to the machine. This is called robot-assisted surgery. The robot makes it possible for the surgeon to move in a very precise way to do complicated keyhole surgery.

During open surgery, the surgeon makes 1 large cut just under the bottom rib or between the 2 bottom ribs. This cut can be up to 30cm long. After the operation, the surgeon stitches or staples the wound closed.

Your recovery after surgery will depend on the type of operation you have.

After the operation, you will be encouraged to start moving around as soon as possible. This can help reduce the risk of some problems.

The most common complications after surgery are:

• a wound infection
• bleeding
• a chest infection
• a blood clot.

The nurses will monitor you for these. Tell them straight away if you:

• feel unwell
• have any bleeding
• notice swelling and redness in any of your arms or legs
• have symptoms of an infection – such as a cough, or leaking wound. 

You will be given a telephone number to call if you need advice when you get home.

After open surgery to the kidney, some people develop a bulge (swelling) along their scar. Doctors call this an incisional hernia. It can happen because of weakness in the muscles around the scar. Tell your doctor or nurse if you develop a bulge around the scar.

We have more information about general complications after surgery.

How long you stay in hospital depends on the type of operation you have and how quickly you recover.

After keyhole surgery, most people go home after 2 to 5 days. After open surgery, most people go home after 5 to 7 days.

Your body uses a lot of energy to heal. It is common to feel more tired than usual for about 6 weeks after the operation. Most people feel they have recovered after about 12 weeks.

You will not be able to do some everyday activities while you recover. For example, you may not be able to shop, drive, have sex, play sport or work. Your nurse or surgeon can tell you when you will be able to do these things again.

Before you leave hospital, you will be given an appointment for a check-up. This is usually about 6 weeks after your operation. It will be at an outpatient clinic. The appointment is a good time to ask questions, or talk about any problems you have after your operation.