Surgery for kidney cancer / (partial) nephrectomy

Surgery for kidney cancer often requires removal of the entire kidney (nephrectomy, although sometimes a part of the kidney can be spared. This is called a partial nephrectomy or kidney sparing treatment.

Partial nephrectomy

if this treatment is an option for you, your urologist will discuss it with you. A partial nephrectomy is mainly performed if the kidney tumor is small (less than 7 cm) and in an appropriate location, preferably on the outside of the kidney.

Unfavorable locations are:
- close to the renal pelvis, causing an increased risk of urine leakage.
- close to the blood vessels that supply the kidney, which may compromise the blood circulation of the kidney.

if the tumor is not in the right location, we will weigh the pros and cons of the treatment. There may be a reason to consider a partial nephrectomy after all (poor kidney function, or in the case of a single kidney). We will discuss this with you.

Nephrectomy

A nephrectomy is the full removal of a kidney.

Surgery

The surgery can be performed in 2 different ways. The type of surgery you will have, depends on a number of factors including your medical history, any additional conditions, and the location of the tumor. Your urologist or clinical nurse specialist will discuss the best treatment option for your specific situation with you. You will be under general anesthesia during all the following types of surgery.

Keyhole surgery (laparoscopic) sometimes assisted by the Da Vinci Robot
The surgery is performed by making a number of smaller incisions in the abdomen, usually five, after which the abdominal cavity is inflated with carbon dioxide. Through a slightly larger incision in the lower abdomen, the kidney (or part of it) is removed. The urologist controls the robot.

Open surgery (laparotomic)
Depending on the size of the tumor, a horizontal cut (incision) is made in the abdomen and/or on the side to remove the affected part of the kidney.

Before your surgery

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

Anesthesia

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

Anesthetics during surgery

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Side effects and complications

All surgical procedures carry risks. Besides these general risks like infection, thrombosis, and pneumonia, you will be at risk for bleedings. Through a set of measures, we try to minimize these risks as much as possible.

Your kidney function may decrease after treatment. Your practicing physician will try to make an estimate of your risks to avoid negative consequences for you. Due to unforeseen circumstances, you may still experience a decrease in kidney function that will require additional treatment.

After kidney removal, you may experience fatigue. This may last a long time. We may not always be able to find a cause for the fatigue - it is a clear signal of the body asking for rest and sleep to recover. Please do not hesitate to take this time to rest.

Checkups after surgery

After your treatment, you will be invited to come in for checkups. The type of checkups will depend on the results of your tissue analysis. Your practicing physician will discuss this with you.