DR. VIVEK VENKAT

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WHAT IS PARTIAL NEPHRECTOMY?

The majority of kidney tumors today are detected incidentally when scans are done for other reasons. This allows detection of tumors at a relatively small size and early stage.

Partial nephrectomy is a surgery where only the tumor is removed leaving the rest of the kidney intact in order to preserve renal function.

This achieves excellent cancer control which is equivalent to removing the entire kidney.

It can be done by an open incision or via a minimally-invasive robotic approach.

WHICH PATIENTS ARE SUITABLE FOR A PARTIAL NEPHRECTOMY?

Surgery is the best treatment for kidney cancers especially those in an early stage.
Partial nephrectomy is the gold standard treatment for tumors smaller than 4cm and is also the best approach for some larger tumors (up to 7cm) which are favourably located i.e. growing outside the kidney.
In patients with pre-existing renal failure, tumors in both kidneys or tumor in a solitary kidney every attempt is made to perform a partial nephrectomy irrespective of tumor size and difficulty.
Patients who have diseases like diabetes or hypertension which can affect the kidney also benefit from partial nephrectomy for kidney cancer if technically possible.
Suspicious cysts (Type III and IV) can be cancerous and are best removed.

WHAT IS THE SUCCESS RATE OF PARTIAL NEPHRECTOMY?

Partial nephrectomy is the gold standard for small renal masses and favourable larger tumors as well.
It has an excellent success rate and depending on the stage more than 80-95% of patients are cured.
Robotic surgery has much lower complications and quicker recovery than open surgery with no compromise in cancer control.
Once the biopsy report is available you can discuss the follow-up schedule and tests with your uro-oncologist.

HOW TO PREPARE FOR PARTIAL NEPHRECTOMY?

After your imaging and staging tests (CT scan or MRI) you will discuss your options with your urologist:

The need for partial or radical nephrectomy?
Whether you are a candidate for a robotic procedure?
What are the chances that you will need a radical nephrectomy even if a partial nephrectomy is planned?
What further treatments might be needed?

To proceed with surgery the general instructions are:

Basic blood and urine tests to assess fitness for surgery
Cardiac evaluation like ECG and 2D-Echo
To stop blood thinning medication for 5-7 days before the surgery
Anesthesia check-up and assessment
Healthy diet and exercise until the surgery
Admission the day prior or day of surgery

What to expect after surgery?

Resumption of a liquid diet within 6-8 hours after surgery and normal food the next day.
You will also be able to get out of bed and walk a few hours after surgery.
Pain after robotic surgery is mild and easily controlled with medications. Open incisions may need stronger painkillers.
You will have a urinary catheter to drain the bladder for 2-3 days.
You will have an abdominal drain which should be removed in 1-2 days.
You are expected to be discharged from hospital in 3-4 days. Patients undergoing open surgery may need to stay longer.
You can resume work in about 2-3 weeks after surgery.
You can walk as much as you like but we recommend avoiding strenuous activity like lifting weights, golfing, going to the gym, etc. for 1 month after surgery.

WHAT ARE THE COMPLICATIONS OF PARTIAL NEPHRECTOMY?

Every surgery carries a risk of complications. General complications may include anesthesia-related problems. infection, blood clots (DVT), pneumonia, cardiac events, etc. In addition, certain specific complications include:

Bleeding – The kidney receives 20% of the blood pumped out from the heart and is a very vascular organ. Bleeding is a risk in these surgeries and transfusion may be required. In partial nephrectomy cutting through the kidney to remove the tumor can cause bleeding. Very rarely ( less than 1%) this may manifest after 3-4 weeks as a pseudoaneurysm or fistula.
Delay in the recovery of intestinal function (ileus) – This can happen after more extensive surgeries and may take up to a week to resolve sometimes.
Urine leak – if a part of the kidney which drains urine (calyx or pelvis) has been cut during a partial nephrectomy urine may leak into the space around the kidney. This generally settles by itself but rarely may need the insertion of a drain or stent.
Need for radical nephrectomy – In case the tumor is more advanced than what was supposed on the scan or there is bleeding which is difficult to control your surgeon may need to perform a radical nephrectomy for safety.

ADVANTAGES OF ROBOTIC PARTIAL NEPHRECTOMY

Robotic surgery provides significant benefits for both patient and surgeon.

Smaller incisions with less pain and scarring
Shorter hospital stay and quick return to normal activities
Reduced bleeding and blood transfusion rates
Lower risk for wound infection
Shorter ischemia time than laparoscopy and equal to open surgery which results in less kidney damage
Excellent magnified view allowing precise closure of blood vessels and collecting system in the tumor bed and closure of the remaining kidney
Much more ergonomic than laparoscopy

FAQs

Who are candidates for partial nephrectomy?

Patients with renal masses less than 4cm in size or larger but technically favourable tumors can undergo partial nephrectomy. Patients with compromised renal function are also candidates.

What are the advantages of robotic surgery?

It allows a very precise surgery with fewer complications, better functional outcomes and no compromise in cancer control.

How painful is the surgery?

For robotic surgery, pain is quite mild and easily managed with tablet medications. Open incisions may need stronger painkillers or an epidural.

When will I be discharged from hospital?

Most patients are discharged in 2-3 days after the surgery.

When can I resume normal work?

Work can be resumed usually 2-3 weeks after surgery.

Will I need additional treatment?

Usually no additional treatment is needed.

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