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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


Overview of cancer treatments


Radical nephrectomy

A radical nephrectomy is surgery that removes the

whole kidney with the tumor and the fatty tissue

around the kidney. This surgery may also remove

the adrenal gland on top of the kidney and nearby

lymph nodes. How much tissue is removed

depends on the extent of the tumor.

Surgery to remove an adrenal gland is called an

adrenalectomy. The attached adrenal gland may

be removed if it looks abnormal on imaging tests.

It may also be removed if the tumor is near the

top part of the kidney where the adrenal gland


Surgery to remove nearby lymph nodes is called

a lymph node dissection. A lymph node dissection

is not often done as part of a standard radical

nephrectomy. Nearby lymph nodes may be

removed if they look enlarged on imaging tests or

feel enlarged during the physical exam.

If the tumor has grown into the renal vein and

vena cava, then the veins may be cut open to

remove all of the cancer. Your heart may need

to be stopped for a short time for surgery on

the vena cava. While the heart is stopped, a

heart-lung machine is used to circulate blood

in the body. This is a very difficult and complex

procedure. It should only be done by a team of

experts who have a lot of experience.

Radical nephrectomy is the standard treatment for

patients with stage II or stage III kidney cancer.

It is also the preferred treatment for tumors that

extend into the vena cava. A radical nephrectomy

can be complex and should only be done by an

expert surgeon who does this type of surgery


Surgery methods

A nephrectomy—partial or radical—can be done with

one of two surgery methods. The first method is called

open surgery. The second method is laparoscopic

surgery, also called minimally invasive surgery.

Open surgery

Open surgery removes tissue through one large

surgical cut below your ribs. The cut may be made in

your belly (abdomen), side, or lower back. The large

cut lets your doctor directly view and access the tumor

in your kidney to remove it. Open surgery may take

several hours or longer. After the surgery, you will

need to stay in the hospital for several days or maybe

longer to recover. You may have some pain in your

side for a few weeks or months after the surgery.

Laparoscopic surgery

Laparoscopic surgery uses a few small incisions

instead of one large one. Small tools are inserted

through each of the cuts to perform the surgery. One

of the tools, called a laparoscope, is a long tube with

a video camera at the end. The camera lets your

doctor see your kidney and other tissues inside your

abdomen. The other tools are used to remove all

or part of the kidney with the cancer. Laparoscopic

surgery can also be done using robotic arms to

control the surgical tools. This is called robot-assisted

laparoscopic surgery.

Laparoscopic surgery may take a couple of hours or

longer to perform. After the surgery, you will need to

stay in the hospital, usually for about 1 to 2 days, to

recover. Laparoscopic surgery often results in less

pain, a shorter hospital stay, and shorter recovery time.