When is this procedure indicated?
When the goal of treatment is to cure localized kidney cancer, surgery is the treatment of choice. Radical nephrectomy is indicated for the treatment of localized kidney cancer not treatable by partial nephrectomy or at locally advanced kidney cancer. Examples of situations in which it is indicated to treat a tumor of the kidney with radical nephrectomy are: when the removal of only diseased tissue with adequate sparing of healthy tissue is impossible due to anatomical characteristics; in case of a very large or aggressive tumor, with involvement of the renal veins, perirenal fat or lymph nodes; or finally in case of severe impairment of kidney function.
How is it performed?
The procedure can be performed using an open surgical approach (through a surgical incision), a laparoscopic approach (through 4 or 5 incisions between 5 and 15 millimeters through which the laparoscopic surgical instruments are inserted) or a robot-assisted approach (through 5 or 6 incisions between 5 and 15 millimeters through which the surgical instruments are connected to the arms of the Da Vinci® Surgical System robot-operator).
The procedure is conducted under general anesthesia and the patient is positioned on his/her side or in a supine position. Surgery may involve: displacement of the liver, ascending colon and duodenum (right kidney) or displacement of the spleen, pancreas, descending colon and sigma (left kidney); isolation of the ureter, isolation and eventual ligation and section of the gonadal vessels (artery and vein); isolation of the renal vessels (one or more veins and one or more arteries) from the vena cava (right kidney) or the aorta (left kidney); isolation, ligation, and sectioning of the renal vessels (one or more veins and one or more arteries); isolation of the kidney from the vena cava (right kidney) or the aorta (left kidney) and other surrounding structures; and removal of the kidney.
In addition to the above maneuvers, it may be necessary, depending on the characteristics of the disease or the patient, to remove the adrenal gland, lymph nodes, or neoplastic thrombi in the veins leading from the kidney. In case of laparoscopic or robotic-assisted approach, a surgical incision is required to remove the kidney from the abdomen after it has been placed in a container.
In 7-8 patients out of 10, no complications are observed after surgery. In some cases the patient may have a fever requiring antibiotic treatment, bleeding may occur requiring transfusion or, even more rarely, interventional maneuvers. Other complications are possible but rare and usually dependent on the patient's baseline health conditions.
Most patients after surgery have a full recovery of their daily activities without any limitation or worsening of their pre-surgery health status. Long-term risks include worsening of overall kidney function with the possibility of renal failure and recurrence of disease locally or systemically, requiring additional care.