Nephrectomy for Kidney Cancer

Kidney cancer accounts for just 3% of all adult cancers, but the incidence is currently rising. In the past, patients typically complained of bloody urine and abdominal pain; the present widespread use and availability of ultrasound and CT scan allow identification of these tumours at an earlier, asymptomatic stage. Whether symptomatic or not, the likelihood of cure relates to the tumour size, smaller the better, and whether the tumour remains confined to the kidney.

There is an 85% chance that a solid kidney lump identified on CT scan, is a cancer.

Benign pathology is more common with smaller tumours <3cm diameter and in woman. Unfortunately, biopsy is unreliable and therefore there is no accurate way to pre-operatively identify the benign tumours which account for 15% of solid kidney lesions. The only effective therapy for kidney cancer is surgical removal and most solid kidney lumps larger than 2-3 cm will ultimately be removed.

The traditional operation (radical nephrectomy) involves removal of the entire kidney through a 6-8 inch abdominal incision. Long-term wound-related problems following this surgery have made laparoscopy a preferable approach to nephrectomy wherever possible, but the open technique is appropriate for some very large tumours, for certain kidney infections, for some partial nephrectomy and as a rescue procedure for intra-operative problems with laparoscopic nephrectomy.

We know from kidney donors that one normal kidney is sufficient for normal kidney function and normal life expectancy. The entire kidney is removed for larger and more central renal tumours. Where there is no opposite kidney, or the opposite kidney is diseased or itself at risk of tumour, the cancer is removed but the remainder of the kidney is preserved (partial nephrectomy). This kidney-conserving surgery may be offered to patients with small tumours and a normal opposite kidney. The early risks from partial nephrectomy are higher than with radical nephrectomy and there is a long-term 2% possibility of tumour recurrence in the remaining portion of kidney.

Nephrectomy, radical or partial, is performed under general anaesthetic. The hospital stay is usually one week, and recovery of normal function takes up to 6 weeks. The kidney, or tumour, is sent for pathological analysis. This may take a few weeks and the results are discussed at the follow-up visit. Follow-up continues for at least 5 years, with annual blood tests, ultrasound to check the remaining kidney, and chest X-ray.

Pre-operatively:

• discontinue aspirin 1 week prior
• some other medications may also need to be stopped
• splenectomy prophylaxis if left nephrectomy
• nil by mouth from midnight, enema evening prior to surgery
• any shaving that is required will be performed in theatre

Post-operatively - early:

• 1st post-operative day: sips of fluids, reinstate usual medications
• day 2: mobilisation, diet as tolerated
• resume full normal activity by 6 weeks

Post-operatively - late:

• regular chest X-ray, renal USS and clinical follow up to 5 years.

Although most cases proceed without particular difficulty and have excellent outcomes, surgical complications occur overall in 5% of patients following radical and 10% of patients following partial nephrectomy. Those complications recognised as common or serious are listed below and include those that apply specifically to partial nephrectomy*. This list does not include the rare and extraordinary. We try at all costs to avoid any adverse outcome.

From data on fit kidney donors, risk of death is 0.03%.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.