What is a nephrectomy? 8 things to know about kidney removal surgery

A nephrectomy is surgery to remove all or part of the kidney. It is most often used to treat kidney cancer.

At UT MD Anderson, we perform about 400 kidney surgeries every year, including nephrectomies. Here, I’ll explain more about nephrectomies, including the different types, when we use each and what to expect while you recover.

Why would I need a nephrectomy?

The most common reason for a nephrectomy is to treat kidney cancer. You may also need a nephrectomy to treat:

• Chronic obstruction of the kidney, due to conditions like kidney stones or ureteral obstructions
• Chronic kidney infection, such as xanthogranulomatous pyelonephritis
• Benign (noncancerous) tumors in the kidney

What do your kidneys do?

Most people are born with two kidneys, one on each side of their back above the waist.

Your kidneys’ main purpose is to filter blood by removing waste, toxins and excess fluids from your blood. The waste is then used to make urine, which flows from your kidneys through ureters and into the bladder. 

Your kidneys also balance fluids and electrolytes in your body, regulate blood pressure and support red blood cell production and bone health. 

Types of nephrectomies

A nephrectomy is considered major surgery. There are two types of nephrectomies.

Partial nephrectomy

A partial nephrectomy is surgery to remove the part of the kidney that is cancerous or damaged while sparing as much healthy tissue as possible. Then the surgeon will repair the remaining part of the kidney.

Radical nephrectomy

A radical nephrectomy is surgery to remove the whole kidney.

Nephrectomy for cancer treatment

Factors such as tumor size, cancer stage and overall kidney function help doctors determine which nephrectomy will best treat the cancer.

Partial nephrectomies are often recommended for small tumors, usually less than four centimeters. Sometimes, we’ll also recommend a partial nephrectomy for tumors that are a little larger than four centimeters if the patient has only one kidney.

In general, a partial nephrectomy is recommended for stage 1 and 2 kidney cancers unless the tumor is located in the middle of the kidney. Sometimes, we’ll do a partial nephrectomy for stage 3 kidney cancer if the patient has only one kidney.

Radical nephrectomies are often performed if the tumor is very big. These are usually used to treat stage 3 kidney cancer.

A nephrectomy is almost never used as first-line treatment for stage 4, or metastatic, kidney cancer. In some cases, a nephrectomy may be considered for these patients if they have been on systemic therapy and the cancer is stable, but that’s still being researched in clinical trials.

How a nephrectomy is done

There are two main surgical approaches to nephrectomies.

• Laparoscopic/robotic: This type of surgery is minimally invasive, which means there are fewer impacts to patients. Surgeons can either use a laparoscope – a thin rod with a camera and surgical tools attached – to perform the surgery, or surgeons can use robots to hold the surgical instruments and control the robots. Surgeons typically make several small incisions in the abdomen for this type of procedure.
• Open: The incision is much longer for an open procedure. Surgeons may take an open surgical approach if a tumor is very large.   

Minimally invasive surgeries typically result in less pain, shorter hospital stays and quicker recovery times than open procedures.

What to expect during a nephrectomy

You will be placed under general anesthesia, so you’ll be asleep during the procedure and won’t feel any pain.

Depending on the type of nephrectomy and the surgical approach, the surgeon will make the incisions and remove the diseased or damaged part of the tumor, or the entire kidney.

At UT MD Anderson, we use an ultrasound to guide us to the tumor during a partial nephrectomy. And because the remaining part of the kidney is reconstructed, a partial nephrectomy usually takes longer than a radical nephrectomy.

On average, a nephrectomy can take between 1 to 3 hours, though it may also take longer.   

Recovery after a nephrectomy

In general, patients will stay one or two nights in the hospital after a robotic nephrectomy or two to four nights after an open nephrectomy. Your surgeon will give you a better idea of how long you’ll need to stay after the procedure.

Your surgical team will monitor you and your kidney function as you recover. They will also provide you with aftercare instructions and any prescriptions you’ll need before you discharge the hospital.

I recommend eating bland foods and drinking a lot of water the first couple of days after surgery. Most people can resume a regular diet a few days after surgery. Your care team will give you specific diet guidance.

Don’t lift anything heavy for the first six weeks after surgery. Most people can resume normal activities after six weeks. Light walking is often encouraged a few days after surgery to help promote blood flow.

Lifestyle changes

Diabetes and high blood pressure are the biggest risk factors for chronic kidney disease, so those should be managed. Obesity is a risk factor for renal cell carcinoma, the most common type of kidney cancer. So, it’s important to maintain a healthy body weight.

People can safely live with one kidney, but kidney function varies by person. If someone had chronic kidney disease before a nephrectomy, their kidney may not function as well as someone who has two healthy kidneys. Chronic kidney disease puts you at a higher risk for having worsening kidney function after a nephrectomy – partial or radical. So, this is something we discuss with each patient before surgery.

Risks

As with any surgery, nephrectomies do carry some risks. These risks are rare.

Risks from anesthesia include:

• Heart attack
• Stroke
• Pneumonia

Surgical risks include:

• Bleeding
• Infection
• Pain near surgical site
• Scar tissue
• Hernia
• Pseudoaneurysm – bleeding from the kidney after a partial nephrectomy that occurs when blood leaks and pools near a damaged artery
• Urine leak – If a tumor’s location requires surgeons to cut into the urinary collection system, it can sometimes cause a urine leak that can become infected.

Partial nephrectomies carry slightly higher risks for complication because the surgeon is cutting directly into the kidney.

See a doctor if you develop any concerning symptoms after surgery, such as blood in your urine, fever or blood clots.

Follow-up

Doctors will send the tumor or kidney to a lab to be reviewed by a pathologist. Once they get the pathology report, your doctor will discuss next steps with you.

This may include any number of things, such as active surveillance or adjuvant therapy. You’ll likely have regular testing to check kidney function as well.

A nephrectomy is a common surgery that can treat many kidney conditions. After recovery, most people return to their normal daily lives and enjoy a good quality of life. Your surgeon and care team are here to treat you and help you remain comfortable throughout the process. Reach out to them with any questions or concerns.

Brittney Cotta, M.D., is a urologic oncologist at UT MD Anderson who specializes in the surgical treatment of cancers of the genitourinary system.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.