Surgery is the most common treatment for kidney cancer. The goal is to take out the tumor or tumors. Sometimes the entire kidney is removed. You may get radiation or other treatment before or after surgery.
Your healthcare provider may advise surgery to treat your kidney cancer if any of these apply to you:
You are healthy enough to have surgery. Your healthcare provider will only suggest surgery if he or she expects you to be able to recover from it.
The tumor is small. In this case, your healthcare provider may do a partial nephrectomy. This surgery allows you to keep some kidney function. Only the part of the kidney that contains the tumor is taken out. This surgery is done if you have only 1 small tumor in 1 kidney. It may also be done if the tumor is larger, but you have cancer in both kidneys or you only have 1 kidney. The benefit is that you keep part of the kidney. The risk is that there's a chance some cancer cells will be left behind.
The tumor is larger, but is only in your kidney. Your healthcare provider will advise the type of surgery you need based on the size and location of the tumor. One option is a simple nephrectomy. This is surgery to take out the entire kidney. Or your healthcare provider may advise a radical nephrectomy. This surgery takes out the whole kidney and the adrenal gland. The adrenal gland is attached to the top of the kidney. Much of the nearby fatty tissue is also taken out. Nearby lymph nodes will also likely be removed (called lymph node dissection). That's because cancer tends to travel to the nodes first. Taking them out may help prevent cancer from spreading to other parts of your body. And testing these lymph nodes helps figure out the stage of the cancer. This is important in deciding if other treatments are needed after surgery.
You have kidney cancer that has spread to only 1 other area. Your healthcare provider may suggest a radical nephrectomy and removal of nearby lymph nodes, as well as removal of the tumors in other parts of your body. There are cases where surgery won’t cure the cancer. But it can help ease symptoms, such as pressure, pain, or bleeding. In some cases, removing the kidney, even when the cancer has spread to other organs, may be recommended. This is because some studies have shown that removing the kidney helps control the remaining disease.
You have symptoms. You may have pain, pressure, or bleeding from tumors that have spread. Your healthcare provider might suggest surgery to remove the tumors. This is done to ease symptoms. It doesn't cure the cancer. You may hear it called palliative therapy.
Kidney cancer surgery may be done in many ways:
Open surgery. This is done through a large cut (incision) made in the skin, fat, and muscle over the belly (abdomen). Or the incision might be made on your side or your back. One of the lower ribs may need to be taken out to reach the kidney. The surgery is then done through this incision.
Laparoscopy. This type of surgery is done through several small incisions in your skin. A thin, flexible tube with a light and camera on the end (called a laparoscope) is put into 1 incision. Long, thin tools are put into the other incisions to do the surgery. Laparoscopy often leads to less time in the hospital after surgery. It tends to cause less pain and scarring and has a faster recovery.
Robotic surgery. This type of surgery is a lot like laparoscopic surgery, but it's done by robot arms that are guided by a surgeon on a computer panel. It's only done at certain surgery centers. And it should only be done by a healthcare provider with a lot of experience. This type of surgery uses smaller incisions and may lead to less pain and scarring after surgery.
All surgery has risks. The risks of kidney surgery include:
Damage to nearby internal organs
Bulging of organs under the incision (hernia)
Air in the chest cavity (pneumothorax)
Kidney failure of the remaining kidney
Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you.
Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask:
What type of surgery will be done
What will be done during surgery
The risks and possible side effects of the surgery
If you'll have kidney function after surgery
When you can go back to doing your normal activities
If the surgery will leave scars and what they'll look like
Before surgery, tell your healthcare team if you are taking any medicines. This includes over-the-counter medicines, vitamins, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you've discussed all the details with the surgeon, you'll sign a consent form that says that the healthcare provider can do the surgery.
You’ll also meet the anesthesiologist and can ask questions about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you certain medicines (called anesthesia) so that you fall asleep and don’t feel pain.
You'll wake up in a recovery room. You'll be watched closely as you fully wake up and are able to talk to the nurses. You may have to stay in the hospital for 2 to 7 days, depending on the type of surgery you had. For the first few days after surgery, you're likely to have pain from the incision. Your pain can be controlled with medicine. Talk with your healthcare provider or nurse about your options for pain relief. Some people don’t want to take pain medicine, but doing so can help your healing. For instance, if you don’t control pain well, you may not want to cough, turn often, or get out of bed, all of which you need to do as you recover from surgery.
You will likely have a urinary catheter for a few days. This a tube put through your urethra (the tube that carries urine out of your body) and into your bladder so that your urine drains into a bag outside your body. In some cases, you may go home with the catheter.
You may have bowel problems right after surgery. If you have diarrhea, ask what you can do about it. Sometimes diet changes can help. Constipation is common from using certain pain medicines, not moving much, or not eating and drinking as much as usual. Talk with your healthcare provider or nurse about getting more dietary fiber or using a stool softener.
When you get home, you may get back to light activity, but you should avoid strenuous activity for at least 6 weeks.
You may feel tired or weak for a while. The amount of time it takes to recover from surgery is different for each person. But you may not feel like yourself for a few months. You'll be able to get your incision wet in the shower. But to reduce your risk of infection, don’t take baths or swim. Ask your healthcare provider when it's OK for you to drive.
Your healthcare team will tell you what kinds of activities are safe for you while you recover.
You may need radiation treatment or biologic therapy after surgery. Your healthcare provider will talk with you about the next steps of treatment and when it will start.
You may need to take medicine when you go home, such as pain medicine or antibiotics. It's important to know what you're taking. Get a written list of the names of all your medicines. Ask your healthcare team how to take them, how they work, what they're for, and what side effects they might cause.
Talk with your healthcare providers about what problems to watch for and when to call them. Let your healthcare provider know right away if you have any of these problems after surgery:
New pain or pain that's worse
Redness, swelling, or fluid leaking from the incision
Changes in how much urine you're making or changes in how it looks or smells
Make sure you know what number to call with problems or questions. Is there a different number for evenings and weekends?