If your doctor is not a surgeon, he or she will refer you to a urologic surgeon, who will determine what type of surgery you should have done. Removing the kidney is called a nephrectomy. Laparoscopic and robotic surgeries have become more commonplace, but have not necessarily demonstrated improved outcomes compared with the traditional open nephrectomy. Before surgery, you’ll meet with your surgeon to talk about the procedure. At this time, you can ask questions and talk about any concerns you may have. Here are some things you may want to talk about:
What type of surgery will be done
What will be done during surgery
The possible risks and side effects of the surgery
When you can expect to return to your normal activities
If the surgery will leave scars and what they will look like
Before surgery, the surgeon will find out if you are taking any medications and will go over your medical records. This is done to make sure you’re not taking medications that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form that says that the doctor can do the surgery.
A surgeon does the surgery in a hospital. Before surgery, you’ll meet the anesthesiologist and can ask questions about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you the anesthesia so that you fall asleep and don’t feel pain.
Your surgeon may need to do an open surgery. That means making a large enough incision for your doctor to use standard surgical instruments for the operation. The incision will be made in your abdomen or at the side of your abdomen. The surgeon may also need to remove one of your ribs. Some centers may have robotic surgery where your surgeon controls a robot that actually does the surgery. This allows for smaller incisions and may promote less pain and scarring.
You may be able to have surgery done laparoscopically. If so, the surgeon makes several small incisions in your abdomen and side. Then, the surgeon inserts a laparoscope, a tool with a camera on it that lets him or her see your kidneys. Other long, thin surgical instruments are then used through the other incisions. You may have less pain, less scarring, and a faster recovery with this type of surgery than with open surgery.
What happens next depends on the type of surgery you are having. The type you have depends on the stage of your cancer. Here’s an overview of the main types of surgery for kidney cancer:
Radical nephrectomy. This is the surgery most commonly used to treat kidney cancer. During this surgery, the surgeon removes your whole kidney with cancer, adrenal gland, fatty tissue surrounding the kidney, and nearby lymph nodes — examining these lymph nodes helps determine the stage of the cancer, which is important in deciding on other treatments.
Simple nephrectomy. During this procedure, the surgeon removes the whole kidney with cancer.
Partial nephrectomy. During this procedure, the surgeon removes only the cancerous part of the kidney. You may have this procedure if you have cancer in both kidneys or if you have only one kidney. It is also becoming more common in people who have a small tumor (smaller than 1.5 inches) in one kidney only.
Surgery to remove metastases. Sometimes, if the cancer has spread to only one or just a few areas, surgery to remove these tumors as well as the main kidney tumor may offer a chance for a cure. In cases where surgery won’t cure the cancer, surgery can sometimes help ease symptoms, such as pressure, pain, or bleeding.
Arterial embolization. This procedure blocks the artery that feeds the kidney with the tumor. The surgeon makes an incision and inserts a small tube, called a catheter, into an artery in your groin. The surgeon moves it through the artery until it reaches your kidney’s artery. Then the surgeon places material, such as small pieces of a special gelatin sponge, in the artery to block it. This is sometimes done before a simple or radical nephrectomy to reduce blood loss during the surgery.
Your doctor will review the option that best suits your medical condition. Make a list of questions before your appointment and have all of them answered before agreeing to treatment. Because such discussions can be confusing and stressful, it's also helpful to bring a trusted family member or friend with you to take notes and help clarify the information.