NCCN Guidelines for Patients
Kidney Cancer, Version 1.2017
Overview of cancer treatments
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
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 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 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 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.