CONSULTANT
CONSULTANT
Jewel Urology Center, Mumbai
Nanavati Hospital, Mumbai
Saifee Hospital, Mumbai
DR. VIVEK VENKAT
Compassionate Evidence-Based Ethical Cancer Care
docvivek@gmail.com
WHAT IS RADICAL OR TOTAL NEPHRECTOMY?
- Radical or total nephrectomy is a surgery where the entire kidney and its surrounding fat along with local lymph nodes are removed.
- In case of kidney tumors, this achieves excellent cancer control and was the treatment of choice for all tumors in the past.
- It can be done by an open incision or via a minimally-invasive robotic approach.
WHEN IS A RADICAL OR TOTAL NEPHRECTOMY NEEDED?
- Surgery is the best treatment for kidney cancers.
- Radical or total nephrectomy is the gold standard treatment for larger tumors (usually more than 7cm), centrally located tumors, tumors involving the blood vessels like renal vein or inferior vena cava, or tumors involving adjacent organs.
- In patients in whom the cancer has spread to other organs a nephrectomy may help control symptoms like pain or bleeding and increase the efficacy of other treatment like chemotherapy or immunotherapy.
- Sometimes if the kidney has become non-functional due to benign diseases like stones, severe infection or birth defects it may be necessary to remove it.
HOW TO PREPARE FOR NEPHRECTOMY?
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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?
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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
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What to expect after surgery?
- Speed of recovery depends on the extent of the surgery.
- After most robotic cases resumption of a liquid diet is 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. For open surgery and more extensive cases like IVC thrombus stronger painkillers or epidural analgesia may be needed.
- Some patients may be kept in the ICU for observation for 1-2 days (IVC thrombus cases or involvement of adjacent organs)
- You will have a urinary catheter to drain the bladder for 1-2 days.
- Most patients undergoing robotic surgery are discharged in 1-2 days. Open cases or more extensive surgeries may need a longer post-operative stay of 3-7 days.
- You can resume work in about 4 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 6 weeks after surgery.
WHAT ARE THE COMPLICATIONS OF NEPHRECTOMY?
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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 with each heartbeat and is a very vascular organ. Kidney cancers generally have a very robust blood supply and can even invade adjacent blood vessels. Bleeding is a significant risk in these surgeries and transfusion may be required.
- 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.
- Injury to adjacent organs – In cases of large tumors, adjacent organs like the spleen, tail of pancreas, intestines, etc. may be stuck to the tumor or affected kidney. Sometimes this cannot be conclusively seen on the CT scan or MRI and the organs may need to be removed during the procedure.
ADVANTAGES OF ROBOTIC SURGERY
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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
- Excellent magnified view allowing precise surgery and preservation of other organs.
- Much more ergonomic than laparoscopy
WHAT ARE THE RESULTS OF NEPHRECTOMY?
WHAT MONITORING IS NEEDED FOR THE SINGLE KIDNEY?
- Radical nephrectomy is the gold standard for larger renal masses.
- It has an excellent success rate and the exact prognosis depends on the stage and pathology of the tumor.
- 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.
- Monitoring your kidney function is important after a nephrectomy especially in patients who have diabetes or hypertension or are obese. Blood pressure levels, sugar monitoring, blood tests like creatinine and urine protein levels are important indicators of kidney function and should be followed regularly.
- Healthy diet with reduced salt, reduced sugar and red meat may be recommended.
- Regular exercise and weight loss in obese patients are important to protect the kidney.
- Avoid dehydration.
- Check with your doctor before taking any medications especially painkillers.
FAQs
Who are candidates for radical or total nephrectomy?
Patients with larger renal masses more than 7cm in size, central tumors or tumors involving blood vessels or adjacent organs may need nephrectomy. Certain benign conditions which lead to non-function of a kidney like stones or severe infection may also necessitate nephrectomy.
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?
Pain is quite mild and easily managed with tablet medications. Open surgery of more extensive procedures may require stronger medications or epidural analgesia.
When will I be discharged from hospital?
Most patients are discharged in 2-3 days after the surgery however this can take longer and depends on the extent of the procedure.
When can I resume normal work?
Work can be resumed usually 3-4 weeks after surgery.
Will I need additional treatment?
Usually no additional treatment is needed.
Can I live a normal life with one kidney?
Definitely – the vast majority of patients live a perfectly normal life with one kidney.
