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 heath.

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
• reduce 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 a glomerular filtration rate (GFR) blood test and a nuclear medicine imaging test called a renogram. 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 types of surgery are 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.

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 a nephrectomy. Where the surgeon makes the cut (incision) 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 surgical cut to reach the kidney.

For laparoscopic surgery, the surgeon makes small cuts and inserts an endoscope. The surgeon uses the endoscope to examine the kidney and surrounding area as well as remove the kidney.

Surgeons will choose to do laparoscopic surgery whenever possible. With laparoscopic surgery there is shorter surgery time, less bleeding during surgery, less pain and a shorter hospital stay.

A partial nephrectomy removes the kidney tumour along with some healthy tissue around it. This surgery leaves the rest of the kidney in place. A partial nephrectomy is sometimes called nephron-sparing, or kidney-sparing, surgery.

Doctors use a 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. 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.

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.

The surgeon can use an open or laparoscopic approach to do a partial nephrectomy. A laparoscopic partial nephrectomy is used for people who have a higher risk of developing kidney problems after surgery.

A radical nephrectomy removes the whole kidney, the ureter attached to the kidney and the layer of fat around the kidney. The adrenal gland is only 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.

A radical nephrectomy isn’t used as often as it was in the past because there is a higher risk of developing chronic kidney damage after this surgery.

The surgeon can use an open or laparoscopic approach to do a radical nephrectomy. A laparoscopic radical nephrectomy is most often done. Open surgery is used for tumours that can’t be removed with a laparoscopic surgery. This includes tumours that are very large, have grown into the renal vein or have grown far into the vena cava. An open approach is also used if the tumour has spread outside the kidney.

A cytoreductive nephrectomy includes a 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. This surgery helps make targeted therapy more effective.

The surgeon can use an open or laparoscopic approach to do a cytoreductive nephrectomy. The advantage of laparoscopic surgery is that the person heals quicker, which means targeted therapy can be started sooner.

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.

Palliative surgery may be done if the tumours can be easily and safely removed.

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 only a few side effects.

If you develop side effects, they can happen 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 (pee) 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 surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.