Radical Nephrectomy

Radical Nephrectomy
Radical Nephrectomy

This surgery involves the removal of the whole kidney on the basis that the tumour within it is cancerous. The kidney and its surrounding fat is removed en bloc to achieve the best possible cure. The surgery is done though open method or laparoscopic / robotic method, the choice depending on the site and size of the tumour. Laparoscopic / robotic method has the advantage of smaller incisions and faster recovery. For small tumours < 4 cm, partial nephrectomy can also be attempted so as to spare most of the kidney. This is especially beneficial for patients who have co-existent diseases eg. hypertension, diabetes mellitus where losing one kidney can accelerate the risk of end-stage kidney failure in later years. As partial nephrectomy is a technically more demanding operation than full nephrectomy with higher complication rates, surgeon experience is important. Nephrectomy surgery takes up to 3 hours. Hospital stay is 4 to 5 days on average.

Complications include:

  • bleeding. This may require blood transfusion if the blood loss is excessive.
  • urine leak. This applies to partial nephrectomy surgery where the collecting system is opened during removal of the tumour. If not repaired with water-tight precision, urine can leak out through the kidney defect.
  • numbness below the wound site. This is due to a cut nerve and is common in open surgery. It may take a few months to recover.
  • bulge below the scar. This occurs with open surgery and is due to muscle weakness. It carries no consequence but may be unsightly.

Desired outcomes:

  • no blood transfusion ( < 3% cases )
  • no wound infection
  • clear margins ( at least 3 mm ) for partial nephrectomy
  • ischemic time < 30 mins for partial nephrectomy
  • no urine leak from kidney for partial nephrectomy