You might have surgery to remove part of your kidney (partial nephrectomy), or your whole kidney (radical nephrectomy).
Surgery can remove:
- cancer that is contained within the kidney (early kidney cancer)
- cancer that has spread into nearby tissues (locally advanced kidney cancer)
The surgery aims to cure the cancer if the surgeon can remove the cancer completely.
If surgery is unlikely to cure your cancer, it can still help. An operation could control the growth and relieve symptoms.
Removing part of a kidney (partial nephrectomy)
This operation is used for small kidney cancers that have not spread. Wherever possible, it’s used to treat stage 1 kidney cancer (less than 7cm across).
The surgeon removes the part of the kidney containing the cancer. Some of the kidney is left behind.
Doctors call this nephron sparing surgery. The nephron is the filtering unit of the kidney – so you have some working kidney left after the operation.
Some people may not be able to have this surgery because of the cancer’s position in the kidney. If you're worried about this, talk it through with your surgeon.
Removing a whole kidney (radical nephrectomy)
The surgeon removes the whole kidney and some of the tissues around it. They also remove some lymph nodes in this area.
Above each kidney is an adrenal gland. You might also have an adrenal gland removed if your surgeon thinks it may contain cancer cells. It is quite unusual for cancer to spread to one of the adrenal glands.
If you have an adrenal gland removed you will be perfectly well with only one. The remaining adrenal gland will make all the hormones you need. It's unusual to have both adrenal glands removed. You would need to take hormone tablets every day if this happens.
A radical nephrectomy is major surgery. But if your cancer hasn't spread, it's all the treatment you will need.
Surgery to relieve symptoms
You might have surgery even if it's unlikely to cure your cancer. This is called a palliative nephrectomy.
Surgery to remove the cancer in your kidney can help with symptoms such as pain or blood in your urine.
In kidney cancer, the tumour can release chemicals called cytokines in your blood. Cytokines can cause symptoms such as drowsiness or sickness. Removing the tumour can reduce or get rid of these symptoms.
Removing the cancerous kidney may also slow down the growth of the cancer outside the kidney, in other parts of your body.
Your specialist can tell you whether surgery is possible for you.
Surgeons can sometimes remove the kidney using small cuts in the tummy (abdomen) instead of making one large cut. This is called keyhole surgery, or laparoscopic surgery.
It is possible to remove a whole kidney or part of a kidney using laparoscopic surgery.
The surgeon uses an instrument a bit like a telescope, called a laparoscope. It has a light at one end and a camera at the other so that the surgeon can see inside your body.
The surgeon usually makes a few small cuts through your skin. They can put the laparoscope and other small instruments through these cuts to carry out the surgery. They watch what they're doing on a monitor.
You end up with 3 or 4 small wounds, each about a centimetre long.
Some hospitals use a machine (robot) to control the laparoscopic instruments during surgery. This is called robotic surgery.
During the surgery a robotic machine is beside you. The machine has 4 arms. One holds the camera and the others hold the surgical instruments.
The surgeon usually makes a few small cuts in your skin. They put the camera and instruments through the cuts.
The surgeon uses a machine to control the robotic arms to carry out the surgery. They have a 3D, magnified view of the operating area.
In the UK this surgery is mainly used at specialist cancer hospitals. It's sometimes called robot assisted surgery or da Vinci surgery.
Benefits and risks of keyhole surgery
Keyhole surgery techniques have different risks and benefits to open surgery.
The advantages of keyhole surgery are you:
- are likely to be more comfortable and need less painkilling medicine after your operation
- can usually go home from hospital more quickly
- usually recover from the operation more quickly
The disadvantages of keyhole surgery are:
- the operation may take longer, so you may be under anaesthetic for longer
- sometimes the surgeon has to switch to regular open surgery during the operation - for example, when the cancer is difficult to reach or there is difficulty controlling bleeding
If you're interested in having keyhole surgery, talk to your surgeon. You may need a referral to a specialist urological surgeon who has experience in it.