What Is Radical Nephrectomy Surgery?
Steps From Pre- to Post-Op
Medically reviewed by Kashif J. Piracha, MD
Radical nephrectomy is the surgical removal of an entire kidney and some of the associated and nearby structures. It may be unilateral, in which only one kidney is removed, or bilateral, in which both kidneys are surgically removed.
In this article, you'll learn what happens with radical nephrectomy, what to know about the recovery timeline, what life is like after this procedure, ongoing care, and more.
Photo composite by Amelia Manley for Verywell Health; Getty Images
Radical Nephrectomy Basics
A radical nephrectomy is performed in a hospital surgical suite under general anesthesia.
In a radical nephrectomy, a surgeon removes the entire kidney (not just a portion of it, as is done in a partial nephrectomy). The ureter will also be removed. This is the tube through which urine flows from the kidney to the bladder.
The layer of fat around the kidney is also taken out. The lymph nodes in the surrounding area and the adrenal gland are also usually removed. The adrenal gland is located on top of the kidney.
If cancer is present in the nearby veins, the veins may be opened to remove the cancer. When the renal vein (the large vein that drains the kidney) or inferior vena cava (which returns blood from the renal vein and lower body to the heart) is affected, the person is placed on cardiopulmonary bypass, with the heart stopped and blood circulated through a heart-lung machine while the veins are repaired.
A radical nephrectomy may be done as a laparoscopic surgery, also known as "keyhole" surgery. A tiny camera (laparoscope) and surgical tools are passed through small incisions in the abdomen, side, or back. This allows the surgeon to view and remove the kidney, which is done through the largest opening.
A laparoscopic nephrectomy may be robot-assisted, with the surgeon guiding the robotic tools.
A radical nephrectomy may be done as an open surgery, which is more invasive and requires a longer recovery time. This involves making a longer incision, 8 to 12 inches, and may even require removing a rib. The kidney and other structures are removed, and the incision is stitched back up.
Open Surgery vs. Laparoscopic Surgery
While traditional open surgery can offer an expanded view during the procedure and may be necessary for those with complicated tumors, it requires a longer recovery time than the more minimally invasive laparoscopic approach. Laparoscopic surgery can be used in more straightforward cases and also minimizes pain and scarring,
Unilateral Nephrectomy
While a person typically has two kidneys, a single kidney is usually sufficient. One can be removed in a unilateral nephrectomy. If your remaining kidney is healthy, you won't need dialysis treatment to remove extra waste products from your system.
Bilateral Nephrectomy
With bilateral nephrectomy, both kidneys are removed. You will need dialysis to do the job of the kidneys in removing waste from your system. Or you will need a kidney transplant.
Partial vs. Radical Nephrectomy
In some cases, you may not need to have the whole kidney removed. Instead, you may be able to undergo partial nephrectomy. This may be done for single small cancerous tumors, but can be done for tumors up to 7 centimeters (about 3 inches) in size.
Whether there are multiple tumors in the kidney, the location of the tumor, and whether the cancer has spread from the kidney are also factors in determining whether a partial or radical nephrectomy is the best option.
Kidney cancers in stage 1 or stage 2 are still within the kidney. But in stages 3 and 4, they have usually spread farther and may need more extensive surgery and other treatments.
Radical Nephrectomy Recovery Timeline
How quickly you recover from a radical nephrectomy will depend on which procedure you undergo. Your hospital stay may vary from just a day to around one week, depending on the approach used.
At first, you will have intravenous lines and a urinary catheter. You may not be able to eat for several days.
To prevent clots, you will be given medication and asked to wear compression socks. You'll likely have pain around the incision and may have numbness where the nerves were cut around the incision. You will also be given breathing exercises to prevent pneumonia (lung infection).
You'll need to avoid strenuous activity and lifting heavy objects for as long as six weeks after the procedure. You should expect to take four to six weeks off from work, depending on your type of work.
Who Qualifies for Nephrectomy Surgery
There are different reasons you may undergo kidney removal surgery. It may be for the sake of your own health or could, instead, be to help someone else out. Here's a closer look at who may qualify here.
Patients
Some of those who may need to undergo the removal of a kidney include the following cases:
Kidney cancer is suspected or found.
A kidney is damaged by infection, disease, or injury.
The kidney was damaged from birth.
Transplant Donors
People can live with just one kidney. Therefore, those with two healthy kidneys could qualify as a living kidney donor for a person whose kidneys are failing. The donor and recipient must be tested to ensure they have compatible blood types.
They must also meet the following qualifications:
Be at least 18
Have a body mass index (BMI) that is not greater than 35 at the time of surgery
Not be a smoker or be able to stop smoking for at least six weeks before donating
Be mentally and physically healthy
Not be pregnant
Radical Nephrectomy: Short- and Long-Term Effects
After undergoing kidney surgery, healthcare providers will keep a watchful eye for signs of complications.
In the short term, you may find yourself feeling tired and weak for a while. You may also experience soreness in the area where the kidney was removed, as well as bruising and redness from the procedure.
As time goes on and you heal from the procedure, you may still need to manage long-term issues that can potentially affect your life. These may include:
Experiencing kidney failure if the remaining kidney does not function well
Developing an incisional hernia from wound healing (the internal organs bulge through the incision)
Having high blood pressure
Nerve damage
Pain
However, keep in mind that these are complications that do not affect everyone. It is possible to live a long, normal life with just one kidney.
Related: Life Expectancy After Kidney Removal
Pain Management
While opioid medication may initially be prescribed for kidney removal, which can be painful at first, this will likely only need to be taken for a couple of days after leaving the hospital. After that, taking Tylenol (acetaminophen) may be all that's needed.
Before Radical Nephrectomy Surgery
With any procedure, there are risks to weigh, and kidney removal is no exception. Be aware that kidney surgery may cause complications.
Risks and Complications to Know
After kidney surgery, there's always the risk of infection. You may develop a urinary tract infection (UTI) or a surgical wound infection. Or, you may develop a chest infection from not breathing deeply enough while recuperating during the early postoperative period.
Also, there's a risk of blood clots developing during the early days when you are unable to move around much.
Preoperative Instructions
If you are slated to undergo kidney removal, you can help to ensure that all goes smoothly by following the preoperative instructions that your surgeon recommends, which may include the following:
Follow the restrictions on when to stop eating and drinking before surgery.
You may be advised to stop taking blood thinners leading up to the procedure.
Avoid smoking, which can interfere with healing.
Take any medications prescribed by your surgeon.
Follow-Up and Ongoing Care
After undergoing kidney removal, your progress will be carefully monitored for signs of complications and to ensure that you are healing properly. You will also be given care for the condition that led to the need for surgery, such as kidney cancer.
If you had one kidney removed, your remaining kidney will be closely watched to make sure it continues to function as it should. You will have routine blood and urine tests and blood pressure checks.
You will need to take steps to protect your remaining kidney and refrain from high-risk activities that may damage it due to collisions or blows. These include martial arts, boxing, contact sports, and skydiving.
If you had both kidneys removed, you will need dialysis. You may also be a candidate for a kidney transplant.
Related: Life Expectancy After Kidney Removal
Summary
Radical nephrectomy is the removal of the entire kidney and associated structures. It may be done using either open or laparoscopic surgery and may mean removing one or both kidneys. Laparoscopic surgery is the easier of the two to undergo and has a shorter recovery time.
Typically, those who undergo radical nephrectomy include those who have kidney damage, cancerous tumors, or an injury to the kidney. It is a major surgery performed in a hospital, with a stay of up to a week.
While radical nephrectomy should not be taken lightly and can cause discomfort, particularly initially, people who have had a kidney removed find that their quality of life is not necessarily negatively impacted.
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