Radical nephrectomy for kidney cancer: a step-by-step overview

Have you ever noticed blood in your urine, a dull pain in your lower back that just won’t go away, or felt unusually tired without any clear reason? These symptoms can be easy to ignore at first. Many people ignore them as minor issues or everyday stress. But sometimes, they can be early warning signs of something more serious — like kidney cancer. Let’s understand what this condition is, its symptoms and treatment options. 

What Is Radical Nephrectomy?

A radical nephrectomy is a surgical procedure performed to treat kidney tumours, cancer, and other kidney conditions. It is carried out by uro surgeons, who remove the entire kidney, surrounding fat, the adrenal gland, and nearby lymph nodes. This procedure helps ensure that the disease is completely treated and does not spread to other parts of the body.

When Is Radical Nephrectomy Recommended?

A radical nephrectomy is recommended when serious disease affects the kidney and it cannot be treated with smaller procedures. Hence, doctors suggest this surgery in the following situations:

• When there is a large tumour in the kidney

• When kidney cancer is confirmed

• When the tumour has grown into nearby tissues, such as blood vessels or surrounding fat

• When the kidney is severely damaged due to infection, injury, or long-term disease and is no longer working properly

• When other treatments, such as partial surgery or medication, are not suitable or have not worked

The aim of this surgery is to remove all diseased tissue. This helps stop the condition from spreading and protects overall health.

Pre-Surgery Preparation for Radical Nephrectomy

Before a radical nephrectomy, your doctor and medical team will prepare you for the surgery. Here’s everything you need to know.

1. Medical Tests and Health Check

Before the surgery, your doctor will recommend a few basic tests to check how well your kidneys are working. Your blood group is tested in case blood is needed during surgery. Your overall health will be checked, such as the following:

• Blood pressure
• Pulse rate
• Body temperature

Based on these tests, your doctor will understand your condition and plan the surgery accordingly.

2. Inform About Your Medicines

You need to tell your doctor about all the medicines you are taking. This includes:

• Prescription medicines
• Over-the-counter medicines
• Herbal or Ayurvedic supplements

Some medicines, especially blood thinners and certain painkillers, can increase the risk of bleeding. 

3. Inform About Allergies

You should inform your doctor if you have any allergies, such as:

• Medicines
• Latex (used in gloves or medical equipment)
• Antiseptic solutions like iodine
• Certain foods

This helps the medical team avoid anything that could cause a reaction during surgery.

4. Eating and Drinking Instructions

You will be given clear instructions about eating and drinking before the surgery. Usually, you must not eat or drink anything for 6 to 8 hours before the procedure. This is because food in the stomach can cause complications during anaesthesia.

5. Understanding the Surgery Plan

Your doctor will explain the following:

• Which kidney will be removed (left or right)
• The type of surgery:
  • Open surgery (larger incision)
  • Laparoscopic or robotic surgery (smaller incisions and faster recovery)

They will also explain what to expect during and after the procedure.

Step-by-Step Procedure of Radical Nephrectomy

A radical nephrectomy is performed in a hospital. Your surgical team will guide you through each step to ensure your safety and comfort.

1. Before the surgery begins

When you arrive at the hospital, your care team will prepare you for surgery. They will check your vital signs, such as blood pressure, pulse and temperature. You may receive fluids or medicines through an IV line. Your doctor will review your reports and confirm the procedure. They will also verify which kidney will be removed.

2. Anesthesia is given

You will receive general anaesthesia before the procedure starts. This means you will be asleep and will not feel any pain during surgery. An anaesthesiologist will monitor you closely throughout the procedure.

3. Making the incision

Your surgeon will begin the operation by making an incision. The type and size of the cut depend on the surgical method:

• In open surgery, a large incision is made in the side or abdomen
• In laparoscopic or robotic surgery, several small incisions are made

These openings allow the surgeon to access the kidney.

4. Accessing the kidney

The surgeon carefully moves surrounding tissues to reach the kidney. They will locate the kidney, nearby blood vessels, and surrounding structures. Special care is taken to avoid damage to nearby organs.

5. Removing the kidney and surrounding tissue

The surgeon will remove the entire kidney. They may also remove surrounding fat, the adrenal gland, and nearby lymph nodes if needed. This step helps ensure that all diseased tissue is removed.

6. Controlling bleeding and closing the incision

After removing the kidney, the surgeon will check for bleeding. They will seal blood vessels and make sure everything is stable. The incision is then closed using stitches or surgical staples. A dressing is placed over the wound.

7. After the surgery

You will be moved to a recovery room. Your care team will monitor your condition as you wake up from anaesthesia. They will check your breathing, heart rate, and pain levels. Once stable, you will be shifted to your hospital room.

Types of Nephrectomy: Open vs Laparoscopic vs Robotic

Nephrectomy is the surgical procedure to remove a kidney. There are three main types of nephrectomy: 

• Open radical nephrectomy: In this method, the surgeon makes a large incision using a surgical knife. The cut can be up to 12 inches (30 cm) long. This approach may be recommended for large kidney tumours or when nearby lymph nodes also need to be removed.
• Laparoscopic radical nephrectomy:  This is a minimally invasive procedure. The surgeon uses a thin instrument with a camera, called a laparoscope, to perform the surgery. Instead of one large cut, several small incisions (usually 0.5 cm to 1 cm) are made. This method is more commonly used than open surgery.
• Robotic radical nephrectomy:  In this approach, the surgeon uses a robotic system to guide small surgical instruments. These instruments are inserted through tiny incisions. Robotic surgery offers similar benefits to laparoscopic surgery, such as smaller cuts and faster recovery.

Open vs Laparoscopic vs Robotic

Feature	Open Nephrectomy	Laparoscopic Nephrectomy	Robotic Nephrectomy
Incision size	Large	Small	Small
Surgical access	Direct	Camera-assisted	Robot-assisted
Recovery time	Longer	Faster	Faster
Pain after surgery	More	Less	Less
Hospital stay	Longer	Shorter	Shorter
Suitability	Complex cases	Selected cases	Selected & complex cases

Recovery and Post-Surgery Care

Recovery after a nephrectomy takes time. Open surgery usually takes longer to heal than laparoscopic or robotic surgery.

1. Hospital Stay: After surgery, you will stay in the hospital for a few days. Doctors and nurses will monitor your condition closely. They will check your blood pressure, pain levels, and kidney function.
2. Pain Management: It is normal to feel pain or discomfort after surgery. Doctors will give pain-relief medicines. The pain will slowly reduce over time. It’s important for you to take your medicines as advised.
3. Wound Care: Keep the surgical area clean and dry. Follow your doctor’s instructions for cleaning and dressing the wound. Watch for signs of infection, such as redness, swelling, pus or discharge & fever
4. Diet and Hydration: Eat a healthy and balanced diet. This helps your body heal faster. You can include fruits and vegetables and light- and easy-to-digest foods in your diet. Drink 2to 3 litres of water.
5. Follow-Up Care: Regular follow-up visits are important. Your doctor will check your recovery and remaining kidney function. Tests may include blood tests, urine tests, imaging scans, and more.

Final Thoughts

A radical nephrectomy is an inpatient surgical procedure used to treat kidney tumours and other kidney-related conditions. During this surgery, the surgeon removes the entire kidney along with the surrounding fat. In some cases, the adrenal gland and nearby lymph nodes may also be removed. Most patients recover fully within 8 to 12 weeks.

FAQs

How long does a radical nephrectomy procedure take?

It usually takes about 2 to 4 hours, depending on the complexity of the case and the surgical method used.

Can a person live with one kidney after surgery?

Yes, most people can live a normal, healthy life with one kidney if they follow medical advice and maintain a healthy lifestyle.

Is robotic nephrectomy better than open surgery?

Robotic surgery often allows quicker recovery and less pain, but the best option depends on the patient’s condition and the surgeon’s recommendation.

What tests are done before radical nephrectomy surgery?

Doctors typically recommend blood tests, urine tests, imaging scans like CT or MRI, and sometimes a biopsy.

Will I need dialysis after kidney removal?

Dialysis is usually not needed if the remaining kidney is healthy and functioning well.

What diet should be followed after nephrectomy?

A balanced diet with low salt, adequate hydration, and limited processed foods is generally recommended.

Does age affect recovery after radical nephrectomy?

Age can influence recovery speed, but overall health and fitness levels play a more important role.