Removing part of the kidney (partial nephrectomy)
This is the most common operation for cancers that are smaller than 4cm. But it may sometimes be done for bigger cancers.
The surgeon removes only the part of the kidney with the cancer. This is called a partial nephrectomy or kidney-sparing surgery. The aim is to remove the cancer, and to leave you with as much normal kidney tissue as possible. This is so the kidney can still work.
Kidney-sparing surgery may also be done if it is important to try to keep the affected kidney. For example, this might happen if you have only one working kidney or have kidney disease. If you have an inherited type of kidney cancer, you may be offered this operation. This is because there is a risk you could develop a cancer in the other kidney. You may be referred to a specialist hospital for this type of surgery. This may mean you have to travel for treatment.
Removing the whole kidney (nephrectomy)
This is when the surgeon removes the whole kidney and some surrounding tissue. This is called a radical nephrectomy. Your surgeon may also remove lymph nodes close to the kidney to check them for cancer cells.
You can live a normal life with one kidney. It will be able to do the work of both kidneys. Removing a kidney is a big operation and is not suitable for everyone. Your doctors may need to do tests to check you are fit enough to cope with the surgery.
If there is cancer in one of the large blood vessels leaving the kidney, it may be possible to have an operation to remove it. But this is a more complicated operation. You will need to go to a specialist hospital for this surgery.
Removing the kidney when the cancer has spread
If the cancer has already spread to other places in the body, your surgeon may still suggest removing the kidney. This will not usually cure the cancer, but it can help some people live longer. It may help other treatments work better and reduce cancer symptoms.
You need to consider 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.
Surgery to remove a secondary cancer
Rarely, an operation may be done to remove a secondary cancer in another part of the body. This is very specialised surgery. It is generally only possible if the cancer has spread to a limited area – usually just to one place in the body. It is also important that you are fit enough to cope with the operation.
Removing a secondary cancer may help control the cancer for longer. Occasionally, it may be used to try to cure the cancer.
Open keyhole and robotic surgery
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.
The surgeon makes one large cut (incision) just under the bottom rib or between the two bottom ribs. This cut can be up to 30cm long. After the operation, the surgeon stitches or staples the wound closed.
Keyhole (laparoscopic) surgery
The surgeon makes two or three small cuts and one larger cut.
They use a laparoscope to see and work inside the tummy (abdomen). The laparoscope is a thin tube with a light and a camera. It sends video images to a monitor. The surgeon puts the laparoscope into the abdomen through one of the small cuts in the skin. They usually make a larger cut close to the belly button. They usually remove the kidney through this cut. The position of the cuts may vary from person to person. Your surgeon can talk to you about this.
Recovery from keyhole surgery is usually quicker than recovery from open surgery. This is because the wound is smaller.
The surgeon may use a specialised machine to help with keyhole surgery. There are instruments attached to the machine, which the surgeon controls. This is called robot-assisted surgery. It makes it possible for the surgeon to do very precise surgery.
Possible complications of kidney cancer surgery
The most common complications after surgery are:
- a wound infection
- a chest infection
- a blood clot.
The nurses will monitor you for these. Let them know straight away if you feel unwell, have any bleeding, or notice swelling and redness in a limb. You should also tell them if you have symptoms of an infection, such as a cough or discharge from your wound.
After open surgery to the kidney, some people develop a bulge along their scar. Doctors call this an incisional hernia. It can happen because of weakness in the muscles around the scar. Let your doctor or nurse know if you develop a bulge around the scar.
Going home 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 an open operation, most people go home after 5 to 7 days.
It is common to feel more tired than usual for about 6 weeks after the operation. Most people feel fully recovered after about 12 weeks.
Your surgeon or nurse can tell you when you will be able to get back to doing everyday activities like shopping, driving, having sex, playing sport or going to work.
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 talk about any problems you have after your operation.